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(Stroke. 2006;37:1967.)
© 2006 American Heart Association, Inc.

Letters to the Editor

Addressing the Guidelines

Tania Mysak, BSP, PharmD

University of Alberta Hospital, Edmonton, Alberta, Canada

Karen Tulloch, BSc (Pharm), PharmD, ACPR

Vancouver General Hospital, Vancouver, British Columbia, Canada

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

To the Editor:

We commend you on the publication of these timely guidelines.¹ Increasingly, those who are involved in the care of stroke patients are heightening their focus toward prevention strategies because there are many modifiable risk factors we can tackle. There are, however, a few areas in the guidelines we would like to address.

First, in the hypertension segment, the recommendation states "Because this benefit (of antihypertensive treatment) extends to persons with and without a history of hypertension, this recommendation should be considered for all ischemic stroke and TIA patients." This recommendation is based on Class IIa, Level B evidence, presumably the PROGRESS study.² However, an important consideration is the definition of hypertension that was used in the PROGRESS study. As stated within the text of the guidelines, patients were classified as hypertensive if their baseline blood pressure was >160 mm Hg systolic or 90 mm Hg diastolic. The mean baseline blood pressure in the nonhypertensive group was 139/79, which according to the JNC VII, is considered prehypertension.³ The JNC VII thereby recommends that patients who have had a stroke and maintain blood pressures above 120/80 should be considered for antihypertensive therapy, and references the PROGRESS study for this recommendation. However, the 2006 stroke guidelines advocate antihypertensive therapy in patients "without a history of hypertension," which could be erroneously interpreted as applying to patients with normal blood pressure (ie, <120/80) and is not supported by the current evidence. Perhaps the authors did not intend to suggest this; . . . [Full Text of this Article]

Related Article:

Response to Letter by Mysak et al

Ralph L. Sacco and Larry B. Goldstein
Stroke 2006 37: 1968. [Extract] [Full Text] [PDF]