Abstract T P309: Early Initiation of Blood Pressure Lowering Medication and the Outcomes of Hypertensive Acute Ischemic Stroke Patients
Background: Elevated blood pressure (BP) in acute stage of ischemic stroke is common but the management of hyperacute hypertension in stroke patients was only vaguely described in the current clinical guidelines. The aim of our study was to determine the effect of expedited initiation of BP-lowering medication on the functional recovery and vascular events after acute ischemic stroke.
Methods: The authors constructed a prospective multicenter registry containing in-hospital BP profiles and BP-lowering medications from 3997 acute ischemic stroke cases. From the data, we selected 841 acute stroke patients who arrived less than 24 hours from onset and who had ≥140 mm Hg of mean systolic BP from ≥3 BP measurement within 24 hours from onset. Initiation of any BP-lowering medications at the day or the next day of stroke onset was defined as “early initiation.” Clinical outcomes of stroke patients have been collected prospectively as quality improvement activity of stroke care and included early neurological deterioration until 3 weeks, mRS score and vascular events at 3 months and 1 year. Adjustment for relevant confounders was performed using ordinal logistic models for mRS scores and using binary logistic models for clinical event outcomes.
Results: Of the 841 stroke cases with mean systolic BP ≥140 during the first 24 hours, early initiation of any BP-lowering medication was documented in 36%. Early initiation group, compared with delayed or none, had more frequent atrial fibrillation (34% vs. 17%) and thrombolytic treatment (23% vs. 17%); other baseline characteristics were well balanced. Multivariable regression analyses showed that early initiation was significantly associated with increasing scores of mRS at 3 months (adjusted OR [95% CI]; 1.33; 1.02 _ 1.73) and at 1 year (1.34; 1.01 _ 1.78). However, early initiation was not linked to any vascular events or mortality after stroke.
Conclusions: Our study documented that early initiation of BP-lowering medication hindered functional recovery after stroke without increasing adverse clinical events.
Author Disclosures: B. Kim: None. M. Han: None. Y. Cho: None. K. Hong: None. S. Park: None. T. Park: None. J. Lee: None. J. Kim: None. J. Yeom: None. J. Lee: None. J. Lee: None. H. Bae: None.
- © 2015 by American Heart Association, Inc.