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Title: Patients With Elevated Blood Pressure After Stroke May Receive Thrombolytic Therapy
URL: http://www.pslgroup.com/dg/22B6F6.htm
Doctor's Guide
September 8, 2008

CHICAGO -- September 8, 2008 -- Patients who require control of severely elevated blood pressure following a stroke do not appear to be at a higher risk for bleeding or other adverse outcomes after receiving thrombolytic therapy, according to a study in the September issue of Archives of Neurology.

"As many as 10% of otherwise eligible patients do not receive tissue plasminogen activator (tPA), the only proved therapy for acute ischemic stroke, because of severely elevated blood pressure," the authors write.

"In the past, guidelines recommended against giving tPA to treat acute ischemic stroke when aggressive measures are required to maintain blood pressure lower than 185/110 millimeters of mercury."

Sheryl Martin-Schild, MD, then of the University of Texas Health Sciences Center, Houston, Texas, and now of Tulane University Health Sciences Center, New Orleans, Louisiana, and colleagues reviewed the medical records of 178 patients with acute ischaemic stroke who received intravenous tPA within 3 hours.

Of these, 50 required treatment for lowering blood pressure before beginning tPA therapy. This included 24 (48%) who received nicardipine, either alone or in combination with labetalol.

"We observed several important differences between patients who required blood pressure-lowering treatment and those who did not," the authors write. "They had more severe strokes and their blood glucose concentration was higher, predicting they would have a worse outcome if all other factors were equal. As expected, they more frequently had a history of hypertension."

After controlling for these factors, including age, baseline stroke severity, and blood glucose levels, there were no differences in adverse events, poor outcomes, or stroke severity scores at discharge between patients who received antihypertensive treatments and those who did not.

"Overall, the results of the present study provide the first experimental support for the revised American Heart Association guidelines allowing tPA therapy in patients requiring aggressive blood pressure management and also provide support for the use of nicardipine in patients with acute ischemic stroke who are eligible for thrombolytic therapy," the authors conclude.

"Aggressive control of severely elevated blood pressure is feasible and should not automatically exclude otherwise eligible patients with acute ischemic stroke from receiving thrombolytic therapy."

SOURCE: Archives of Neurology

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