More than Half Hospitalized Stroke Patients Likely Treated for Hypertension Against Guidelines

As many as 65 percent of stroke patients are likely to be treated with antihypertensive medications during the first four days of hospitalization, despite current guidelines of the American Stoke Association that recommend against treating all but the most severe cases of hypertension during the first few days following a stroke. A recent retrospective study found that nearly all stroke patients who were being treated for hypertension prior to admission had their medication regimens continued or intensified, and a third who were not taking medications for hypertension had antihypertension treatment initiated during the hospitalization. Study details are published in the July 27 issue of Neurology.

Hypertension (high blood pressure) is common at the time of an ischemic stroke and is believed to be the body’s response that maintains adequate blood flow to the area immediately around the stroke site. Lowering elevated blood pressure through medication, while an appropriate measure in stroke prevention, can result in the extension and worsening of acute stroke symptoms, and has even been shown to result in worse short- and long-term outcomes.

The dangers of antihypertensive therapy in the setting of acute ischemic stroke have been recognized for some time. Despite active efforts to promote clinical guidelines, first established in 1994, little is known about how often, and under what circumstances, antihypertensive agents are used in the treatment of patients with acute ischemic stroke. “We sought to determine whether the use of antihypertensive agents was consistent with guidelines, and if such use placed patients at further risk of negative outcomes,” noted study author Peter Lindenauer, MD, MSc, of Baystate Medical Center and Tufts University School of Medicine, Springfield.

For the study, researchers reviewed the medical records of 154 patients admitted in 2000 for acute ischemic stroke at Baystate Medical Center, a community-based teaching hospital that serves as the western campus of Tufts University School of Medicine. Overall, the incidence of hypertension severe enough to warrant antihypertensive treatment (according to guidelines) was low, varying from 17 percent among those whose medications regimens were continued to 36 percent among those whose regimens were intensified. Only 26 percent of patients who had antihypertensive therapy initiated in the hospital met guideline criteria for treatment.

The majority of the patients who were prescribed antihypertensive medications experienced relative hypotension on the days that they received treatment, and one in 20 treated patients developed frank hypotension.

“Antihypertensive agents are used more frequently in the care of stroke patients than is currently recommended by clinical practice guidelines,” concluded Dr. Lindenauer. “In light of how frequently stroke is encountered in the hospital setting, continued research focused on blood pressure management should be supported.” In the meantime, Lindenauer emphasized that greater efforts should be made to educate physicians about the potential risks associated with this practice.

Stroke is a leading cause of disability and the third leading cause of death in the United States.

The American Academy of Neurology, an association of more than 18,000 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as stroke, Alzheimer’s disease, epilepsy, Parkinson’s disease and multiple sclerosis.