65% of hospitalized stroke patients given wrong treatment

The current guidelines of the American Stroke Association recommend against treating all but the most severe cases of hypertension during the first few days following a stroke. Research has shown that lowering elevated blood pressure through medication right after a stroke can result in the extension and worsening of acute stroke symptoms, and has even been shown to cause in worse short- and long-term outcomes.

Despite this warning, as many as 65% of stroke patients are likely to be treated with antihypertensive medications during the first four days of hospitalization, putting their lives and recovery in jeopardy.

A recent retrospective study found that nearly all stroke patients who were being treated for hypertension prior to admission had their medication regimens continued or intensified, and a third who were not taking medications for hypertension had antihypertension treatment initiated during the hospitalization. Study details were published in the July 27 issue of Neurology.

Hypertension (high blood pressure) is common at the time of an ischemic stroke and is believed to be the body’s response that maintains adequate blood flow to the area immediately around the stroke site.

The dangers of antihypertensive therapy in the setting of acute ischemic stroke have been recognized for some time. Clinical guidelines were first established in 1994.

For the study, researchers reviewed the medical records of 154 patients admitted in 2000 for acute ischemic stroke in a community-based teaching hospital.

“Antihypertensive agents are used more frequently in the care of stroke patients than is currently recommended by clinical practice guidelines,” concluded Dr. Lindenauer. “In light of how frequently stroke is encountered in the hospital setting, continued research focused on blood pressure management should be supported.” In the meantime, Lindenauer emphasized that greater efforts should be made to educate physicians about the potential risks associated with this practice.

Stroke is a leading cause of disability and the third leading cause of death in the United States.

SOURCE: “Use of antihypertensive agents in the management of patients with acute ischemic stroke,” Neurology, July 27 2004.