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(Stroke. 2004;35:526.)
© 2004 American Heart Association, Inc.

Original Contributions

Editorial Comment—Persisting Dilemma: To Treat or Not to Treat Blood Pressure in Acute Ischemic Stroke

Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Treatment of blood pressure in acute stroke is controversial, whether attempts are made to reduce or to increase blood pressure. Few clinical studies are available to guide clinicians. A Cochrane review¹ on deliberately altering blood pressure within 2 weeks of stroke onset found 5 small trials, involving 218 patients randomized to nimodipine, nicardipine, captopril, clonidine, glyceryl trinitrate, or perindopril versus placebo or control treatment. The limited number of data made it impossible to assess the relationship between blood pressure and clinical outcome.

Ahmed et al² made a post hoc analysis on the effect of intravenous nimodipine in acute ischemic stroke within 24 hours. They found that a reduction of diastolic blood pressure of about 15 mm Hg was associated with poor outcome, whereas a spontaneous fall in the placebo group of about 8 mm Hg was associated with a better outcome.

In this issue of Stroke, Castillo et al found that a fall in systolic blood pressure of more than 20 mm Hg was associated with neurological deterioration and poor outcome. This was an observational study in 258 acute stroke patients, of whom many had their blood pressure lowered. Antihypertensive treatment was started already in the emergency department by other doctors than those involved in the study. The blood pressure–lowering treatment was given according to international guidelines, which, however, are based on reasoning rather than on evidence. Antihypertensive drugs were given to 38.7% of patients with early neurological deterioration versus 16.9% in those without deterioration, P<0.05. In patients . . . [Full Text of this Article]

This article has been cited by other articles:

				G. Tsivgoulis, K. Spengos, K. N. Vemmos, J. Castillo, and A. Davalos Blood Pressure in Acute Stroke and Its Prognostic Value * Response Stroke, August 1, 2004; 35(8): 1786 - 1787. [Full Text] [PDF]