Although the benefit of reducing blood pressure for primary and secondary prevention of stroke has been established, the effect of antihypertensive treatment in patients with acute ischemic stroke is uncertain. Among patients with acute ischemic stroke, blood pressure reduction with antihypertensive medications, compared with the absence of hypertensive medication, did not reduce the likelihood of death and major disability at 14 days or hospital discharge. Clinical trials have documented that lowering blood pressure reduces the risk of stroke in hypertensive and normotensive patients with a history of stroke or transient ischemic attack. Although the benefit of lowering blood pressure for primary and secondary prevention of stroke has been established, the effect of immediate antihypertensive treatment in patients with acute ischemic stroke and elevated blood pressure is uncertain. Elevated blood pressure is common during acute ischemic stroke. In the US National Hospital Ambulatory Medical Care Survey, 76.5% of patients with acute ischemic stroke had systolic blood pressures of 140 mm Hg or greater on arrival at the emergency department. Observational studies have reported that a decrease in blood pressure within the first 48 hours after symptom onset was associated with poorer, better, or no difference in adverse clinical outcomes among patients with acute ischemic stroke. There are no published clinical trials with sufficient statistical power to address the question of whether lowering blood pressure reduces adverse clinical outcomes among patients with acute ischemic stroke. JAMA. 2014;311(5):479-489. doi:10.1001/jama.2013.282543.
Posted on: Fri, 09 May 2014 02:24:58 +0000
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