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High blood pressure in acute ischaemic stroke--broadening therapeutic horizons.
Cerebrovasc Dis 2009; 27 Suppl 1:156-61CD

Abstract

High blood pressure (BP) is present in 80% of patients with acute ischaemic stroke and is independently associated with poor outcome. Although this epidemiology suggests that BP should be lowered acutely, concerns about dysfunctional cerebral autoregulation suggest otherwise. Several small randomised trials have assessed cerebral blood flow with various antihypertensive classes and agents in acute ischaemic stroke. Overall, these studies showed no change in cerebral perfusion, although the numbers of studies and patients are limited and there are methodological problems with some trials. There are no large published randomised trials assessing outcome with BP lowering in acute stroke. Calcium channel blockers did not alter outcome after ischaemic stroke (29 trials, 7,665 patients). However, some trials, especially those testing intravenous calcium channel blockers (INWEST) or oral beta-receptor antagonists (BEST) reported real or potential hazard. In contrast, oral candesartan reduced combined vascular events in 339 patients with ischaemic stroke (ACCESS) although it had no effect on disability. The CHHIPS trial found that death was reduced in patients randomised to active treatment (labetalol, lisinopril) as compared with placebo. Two larger trials reported that glucose-potassium-insulin therapy (GIST) or magnesium (IMAGES) lowered BP but had no effect on functional outcome. The INTERACT pilot trial studied patients with intracerebral haemorrhage and found that an intensive BP-lowering regime non-significantly reduced haematoma expansion. There are four large ongoing trials examining whether to continue or stop pre-stroke antihypertensive therapy (COSSACS, ENOS) or lower BP in acute stroke (ENOS, SCAST) or haemorrhage (INTERACT 2).

Authors+Show Affiliations

Stroke Trials Unit, Institute of Neuroscience, University of Nottingham, Nottingham, UK.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

19342846

Citation

Sare, Gillian M., et al. "High Blood Pressure in Acute Ischaemic Stroke--broadening Therapeutic Horizons." Cerebrovascular Diseases (Basel, Switzerland), vol. 27 Suppl 1, 2009, pp. 156-61.
Sare GM, Geeganage C, Bath PM. High blood pressure in acute ischaemic stroke--broadening therapeutic horizons. Cerebrovasc Dis. 2009;27 Suppl 1:156-61.
Sare, G. M., Geeganage, C., & Bath, P. M. (2009). High blood pressure in acute ischaemic stroke--broadening therapeutic horizons. Cerebrovascular Diseases (Basel, Switzerland), 27 Suppl 1, pp. 156-61. doi:10.1159/000200454.
Sare GM, Geeganage C, Bath PM. High Blood Pressure in Acute Ischaemic Stroke--broadening Therapeutic Horizons. Cerebrovasc Dis. 2009;27 Suppl 1:156-61. PubMed PMID: 19342846.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High blood pressure in acute ischaemic stroke--broadening therapeutic horizons. AU - Sare,Gillian M, AU - Geeganage,Chamila, AU - Bath,Philip M W, Y1 - 2009/04/03/ PY - 2009/4/4/entrez PY - 2009/4/15/pubmed PY - 2009/6/11/medline SP - 156 EP - 61 JF - Cerebrovascular diseases (Basel, Switzerland) JO - Cerebrovasc. Dis. VL - 27 Suppl 1 N2 - High blood pressure (BP) is present in 80% of patients with acute ischaemic stroke and is independently associated with poor outcome. Although this epidemiology suggests that BP should be lowered acutely, concerns about dysfunctional cerebral autoregulation suggest otherwise. Several small randomised trials have assessed cerebral blood flow with various antihypertensive classes and agents in acute ischaemic stroke. Overall, these studies showed no change in cerebral perfusion, although the numbers of studies and patients are limited and there are methodological problems with some trials. There are no large published randomised trials assessing outcome with BP lowering in acute stroke. Calcium channel blockers did not alter outcome after ischaemic stroke (29 trials, 7,665 patients). However, some trials, especially those testing intravenous calcium channel blockers (INWEST) or oral beta-receptor antagonists (BEST) reported real or potential hazard. In contrast, oral candesartan reduced combined vascular events in 339 patients with ischaemic stroke (ACCESS) although it had no effect on disability. The CHHIPS trial found that death was reduced in patients randomised to active treatment (labetalol, lisinopril) as compared with placebo. Two larger trials reported that glucose-potassium-insulin therapy (GIST) or magnesium (IMAGES) lowered BP but had no effect on functional outcome. The INTERACT pilot trial studied patients with intracerebral haemorrhage and found that an intensive BP-lowering regime non-significantly reduced haematoma expansion. There are four large ongoing trials examining whether to continue or stop pre-stroke antihypertensive therapy (COSSACS, ENOS) or lower BP in acute stroke (ENOS, SCAST) or haemorrhage (INTERACT 2). SN - 1421-9786 UR - https://www.unboundmedicine.com/medline/citation/19342846/High_blood_pressure_in_acute_ischaemic_stroke__broadening_therapeutic_horizons_ L2 - https://www.karger.com?DOI=10.1159/000200454 DB - PRIME DP - Unbound Medicine ER -