High blood pressure after stroke should not necessarily rule out use of clot-busting treatment

Sep 08, 2008

Patients who require therapy to lower their blood pressure following a stroke do not appear to be at a higher risk for bleeding or other adverse outcomes after receiving anti-clotting therapy, according to a report in the September issue of Archives of Neurology, one of the JAMA/Archives journals.

Patients who have an acute ischemic stroke—in which a clot blocks blood flow to the brain—often have elevated blood pressure, according to background information in the article. "As many as 10 percent of otherwise eligible patients do not receive tissue plasminogen activator (tPA), the only proved therapy for acute ischemic stroke, because of severely elevated blood pressure," the authors write.

"In the past, guidelines recommended against giving tPA to treat acute ischemic stroke when aggressive measures (such as continuous infusion or more than two infusions of anti-hypertensive agents) are required to maintain blood pressure lower than 185/110 millimeters of mercury."

Sheryl Martin-Schild, M.D., Ph.D., then of the University of Texas Health Sciences Center at Houston and now of Tulane University Health Sciences Center, New Orleans, and colleagues reviewed the medical records of 178 patients with acute ischemic stroke who received intravenous tPA within three hours. Of these, 50 required treatment for lowering blood pressure before beginning tPA therapy. This included 24 (48 percent) who received the medication nicardipine, either alone or in combination with the drug labetalol.

"We observed several important differences between patients who required blood pressure–lowering treatment and those who did not," the authors write. "They had more severe strokes and their blood glucose concentration was higher, predicting they would have a worse outcome if all other factors were equal. As expected, they more frequently had a history of hypertension."

After controlling for these factors—including age, baseline stroke severity and blood glucose levels—there were no differences between patients who received antihypertensive treatments and those who didn't in adverse events, poor outcomes or stroke severity scores at discharge.

Source: JAMA and Archives Journals

Explore further: Prevention of costly hip fractures should be a priority in UK

add to favorites email to friend print save as pdf

Related Stories

More flavorful, healthful chocolate could be on its way

Mar 24, 2015

Chocolate has many health benefits—it can potentially lower blood pressure and cholesterol and reduce stroke risk. But just as connoisseurs thought it couldn't get any better, there's this tasty new tidbit: ...

High blood pressure may lead to 'silent' strokes

Jul 27, 2009

"Silent" strokes, which are strokes that don't result in any noticeable symptoms but cause brain damage, are common in people over 60, and especially in those with high blood pressure, according to a study published in the ...

Recommended for you

Third Minnesota turkey farm hit by bird flu outbreak

21 hours ago

An outbreak of a bird flu strain that's deadly to poultry deepened Saturday when state and federal officials confirmed a third Minnesota turkey farm has been infected, this time in one of the state's top poultry producing ...

User comments : 0

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.