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Should hypertension be treated after acute stroke? A randomized controlled trial using single photon emission
D R Lisk1, J C Grotta, L M Lamki
1Department of Neurology, University of Texas Health Science Center, Houston 77030.
Archives of Neurology
|August 1, 1993
Summary
Hypertensive patients with acute ischemic stroke may not need immediate blood pressure medication. Certain drugs, like nicardipine, can excessively lower blood pressure and harm cerebral blood flow, requiring cautious use.
Area of Science:
- Neurology
- Cardiology
- Pharmacology
Background:
- Hypertension is a common comorbidity in patients experiencing acute ischemic stroke.
- The optimal management of blood pressure in the immediate post-stroke period for hypertensive individuals remains a critical clinical question.
Purpose of the Study:
- To investigate the efficacy and safety of antihypertensive medications in previously hypertensive patients following an acute ischemic stroke.
- To assess the impact of immediate post-stroke antihypertensive treatment on blood pressure, cerebral blood flow, and clinical outcomes.
Main Methods:
- A randomized, double-blind, placebo-controlled trial was conducted.
- Sixteen hypertensive patients with middle cerebral artery infarction received either placebo, nicardipine, captopril, or clonidine for three days.
- Outcomes measured included blood pressure changes, cerebral blood flow (CBF) via SPECT, and clinical status using the NIH Stroke Scale.
Main Results:
- Blood pressure decreased significantly in both drug-treated and placebo groups, with no significant difference between them.
- Nicardipine resulted in consistently lower blood pressure compared to other interventions.
- A negative correlation was observed between the degree of blood pressure reduction and improvement in cerebral blood flow.
- Four patients experienced a >16% blood pressure drop, leading to impaired or decreased cerebral blood flow, with three receiving nicardipine.
- No significant clinical differences were observed between placebo and drug-treated groups.
Conclusions:
- Antihypertensive therapy may not be necessary for hypertensive ischemic stroke patients with moderate blood pressure elevation in the early post-stroke phase.
- Calcium channel blockers, such as nicardipine, should be used cautiously due to the risk of excessive blood pressure reduction and compromised cerebral blood flow.
- Further research is warranted to establish definitive guidelines for blood pressure management in this patient population.