Abstract T P268: Restarting Antihypertensive Medications in Acute Ischemic Stroke (AIS) with Pre-Existing Diagnosis of Hypertension: What is the Current Practice and Trends?
Background/Issue: Practitioners do not have clear guidelines on when to restart antihypertensive medications in an AIS patient with pre-existing diagnosis hypertension. The current guidelines by the American Heart Association states to restart antihypertensive medications within 24 hours of AIS is relatively safe especially in patients with pre-existing hypertension and who are neurologically stable(Class IIa; Level B). Currently there are no set guidelines for providers to follow for blood pressure control or what point during the admission the blood pressure should be treated.
Purpose: The purpose of study was to review the current practice for providers caring for AIS patients and when antihypertensive medications were restarted.
Methods: A retrospective cohort study of 240 charts was reviewed from a five hospital campuses during the months of May and June 2013. Inclusion criteria included for the study consisted of discharge diagnosis of ischemic stroke, pre-existing diagnosis of hypertension, and the patients was prescribed antihypertensive medications prior to admission. Charts were reviewed for: when home antihypertensive medication regimen was restarted, if the antihypertensive medication was held, and if so, was there a documented reason. Exclusion criteria consisted of: diagnosis of hypertension prior to admission, but the patient was not on any medication; or newly diagnosis of hypertension.
Results: Of the 240 charts reviewed, 49 patients were identified with the pre-existing hypertension, currently taking antihypertensive medication, and discharged diagnosis with AIS. Of the 49 patients, 67% had antihypertensive medication restarted, while 33% of patient’s antihypertensive were held or restarted at time of discharge. On the day of hospital admission, 66% were restarted on home medications, while 34% of the patients had home medications held. Of those who held the home medications, approximately 8% of providers documented a reason.
Conclusions: While more than half of the patients with AIS with hypertension had home medications restarted, providers inconstantly documented reasons why antihypertensive medications were held. There needs to be clarification in documentation in order to determine the variation in practice.
Author Disclosures: L.D. Berger: None. L. Olson-Mack: None. C. Bajkiewicz: None. K. Clarkson: None. R. Richetts: None.
- © 2014 by American Heart Association, Inc.