Almost two thirds of acute stroke patients are likely to receive antihypertensive drugs despite guidelines recommending treatment for only the most severe cases of hypertension during the first days following a stroke, according to an article in the July 27th issue of Neurology.

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 during their hospitalization, and one third of patients not taking medications for hypertension had antihypertension treatment initiated during the hospitalization. These practice facts fly in the face of theory on maintaining optimal blood flow to brain regions adjacent to the stroke site.

Hypertension 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. Lowering elevated blood pressure through medication, while an appropriate measure in stroke prevention, can result in extension and worsening of acute stroke symptoms, and has even been shown to result in worse short- and long-term outcomes.

The dangers of antihypertensive therapy in the setting of acute ischemic stroke have been recognized for some time. Despite active efforts to promote clinical guidelines, first established in 1994, little is known about how often, and under what circumstances, antihypertensive agents are used in the treatment of patients with acute ischemic stroke.

“We sought to determine whether the use of antihypertensive agents was consistent with guidelines, and if such use placed patients at further risk of negative outcomes,” noted study author Peter Lindenauer, MD.

For the study, researchers reviewed the medical records of 154 patients admitted in 2000 for acute ischemic stroke at a single US community-based teaching hospital. Overall, the incidence of hypertension severe enough to warrant antihypertensive treatment (according to guidelines) was low, varying from 17 percent among those whose medications regimens were continued to 36 percent among those whose regimens were intensified. Only 26 percent of patients who had antihypertensive therapy initiated in the hospital met guideline criteria for treatment.

The majority of patients who were prescribed antihypertensive medications experienced relative hypotension on the days they received treatment, and 1 in 20 treated patients developed frank hypotension.

“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.