Response to Letter by Tsivgoulis et al
We appreciate the interest of Tsivgoulis et al in our article on blood pressure (BP) course during the initial week after different subtypes of ischemic stroke.1 Among methodological issues of our study which their letter raises, the most essential one appears to be relatively frequent use of antihypertensives or coronary vasodilators during acute stroke in the cardioembolic patients. On admission, ultrasound and magnetic resonance angiography were performed for almost all of our stroke patients to detect cerebrovascular occlusion/stenosis which might cause cerebral hypoperfusion. For patients without such vascular lesions, who had extremely high BP or severe cardiovascular comorbidities, we did not hesitate to lower acute BP to some extent. Our recent study2 showed that advanced renal damage, as well as poorly controlled diabetes mellitus, was related to high acute BP during the first 36 hours of hospitalization which met the criteria of the Acute Candesartan Cilexetil Therapy in Stroke Survivors (ACCESS) study.3 Early treatment with antihypertensives, including an angiotensin type 1 receptor blocker, might be protective against progression of such organ damages. Several ongoing trials may change strategies for BP management during acute stroke in the near future.
Toyoda K, Okada Y, Fujimoto S, Hagiwara N, Nakachi K, Kitazono T, Ibayashi S, Iida M. Blood pressure changes during the initial week after different subtypes of ischemic stroke. Stroke. 2006; 37: 2637–2639.
Schrader J, Luders S, Kulschewski A, Berger J, Zidek W, Treib J, Einhaupl K, Diener HC, Dominiak P; Acute Candesartan Cilexetil Therapy in Stroke Survivors Study Group. The ACCESS Study: evaluation of Acute Candesartan Cilexetil Therapy in Stroke Survivors. Stroke. 2003; 34: 1699–1703.