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Blood pressure management in acute stroke: comparison of current guidelines with prescribing patterns.
Can J Neurol Sci. 2002 May; 29(2):125-31.CJ

Abstract

OBJECTIVE

Current recommendations for treating elevated blood pressure (BP) in the acute stroke are based largely on expert opinion and vary with regard to treatment thresholds and choice of antihypertensive agents. In this study we investigate the influence of these recommendations by comparing the management of hypertension in acute stroke at a tertiary care hospital with current guidelines.

METHOD

Retrospective chart review of patients admitted with acute stroke at The Ottawa Hospital-General Campus over six consecutive months. The use of antihypertensive medications (type, dose, routes of administration, BP recordings) in the first seven days after admission was noted.

RESULTS

Transdermal nitroglycerin paste was the most commonly used antihypertensive agent. In contrast to the 15% reduction in BP over 24 hours recommended for lowering BP in hypertensive patients with ischemic stroke, nitroglycerin caused a >15% reduction of BP over the first 24 hours on 60% of the occasions used. Furthermore, despite concerns about sublingual nifedipine, this was the second most commonly prescribed agent. Surprisingly, the mean time to first BP measurement following initiation of antihypertensive therapy was 117 +/- 43 minutes in ischemic stroke and 88 +/- 89 minutes in hemorrhagic strokes.

CONCLUSIONS

The current guidelines for management of acute poststroke hypertension appear to have little influence on prescribing patterns, leading to considerable variations in practice. Such variations, likely due to uncertainty caused by lack of evidence from randomised controlled trials, are intolerable as patients maybe submitted to nonstandardised, potentially harmful care such as inappropriate choice of antihypertensives and inadequate BP monitoring as observed in this study.

Authors+Show Affiliations

Kanji S
Department of Pharmacy, The Ottawa Hospital, University of Ottawa, ON, Canada.
Corman C
No affiliation info available
Douen AG
No affiliation info available

MeSH

AdultAgedAged, 80 and overAntihypertensive AgentsBlood PressureCerebral HemorrhageFemaleHumansHypertensionMaleMiddle AgedNitroglycerinPractice Patterns, Physicians'Retrospective StudiesStrokeTreatment OutcomeVasodilator Agents

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12035833

Citation

Kanji, Salmann, et al. "Blood Pressure Management in Acute Stroke: Comparison of Current Guidelines With Prescribing Patterns." The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques, vol. 29, no. 2, 2002, pp. 125-31.
Kanji S, Corman C, Douen AG. Blood pressure management in acute stroke: comparison of current guidelines with prescribing patterns. Can J Neurol Sci. 2002;29(2):125-31.
Kanji, S., Corman, C., & Douen, A. G. (2002). Blood pressure management in acute stroke: comparison of current guidelines with prescribing patterns. The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques, 29(2), 125-31.
Kanji S, Corman C, Douen AG. Blood Pressure Management in Acute Stroke: Comparison of Current Guidelines With Prescribing Patterns. Can J Neurol Sci. 2002;29(2):125-31. PubMed PMID: 12035833.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Blood pressure management in acute stroke: comparison of current guidelines with prescribing patterns. AU - Kanji,Salmann, AU - Corman,Céline, AU - Douen,Andre G, PY - 2002/5/31/pubmed PY - 2002/11/26/medline PY - 2002/5/31/entrez SP - 125 EP - 31 JF - The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques JO - Can J Neurol Sci VL - 29 IS - 2 N2 - OBJECTIVE: Current recommendations for treating elevated blood pressure (BP) in the acute stroke are based largely on expert opinion and vary with regard to treatment thresholds and choice of antihypertensive agents. In this study we investigate the influence of these recommendations by comparing the management of hypertension in acute stroke at a tertiary care hospital with current guidelines. METHOD: Retrospective chart review of patients admitted with acute stroke at The Ottawa Hospital-General Campus over six consecutive months. The use of antihypertensive medications (type, dose, routes of administration, BP recordings) in the first seven days after admission was noted. RESULTS: Transdermal nitroglycerin paste was the most commonly used antihypertensive agent. In contrast to the 15% reduction in BP over 24 hours recommended for lowering BP in hypertensive patients with ischemic stroke, nitroglycerin caused a >15% reduction of BP over the first 24 hours on 60% of the occasions used. Furthermore, despite concerns about sublingual nifedipine, this was the second most commonly prescribed agent. Surprisingly, the mean time to first BP measurement following initiation of antihypertensive therapy was 117 +/- 43 minutes in ischemic stroke and 88 +/- 89 minutes in hemorrhagic strokes. CONCLUSIONS: The current guidelines for management of acute poststroke hypertension appear to have little influence on prescribing patterns, leading to considerable variations in practice. Such variations, likely due to uncertainty caused by lack of evidence from randomised controlled trials, are intolerable as patients maybe submitted to nonstandardised, potentially harmful care such as inappropriate choice of antihypertensives and inadequate BP monitoring as observed in this study. SN - 0317-1671 UR - https://www.unboundmedicine.com/medline/citation/12035833/Blood_pressure_management_in_acute_stroke:_comparison_of_current_guidelines_with_prescribing_patterns_ L2 - https://medlineplus.gov/highbloodpressure.html DB - PRIME DP - Unbound Medicine ER -