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Management of Hypertension in Ischemic Stroke: AAFP 2006

By Sandra Pelus

WASHINGTON, DC -- October 4, 2006 -- Available data support the use of diuretics alone and in combination with an angiotensin-converting enzyme inhibitor (ACEI), according to a presentation made here at the American Academy of Family Physicians (AAFP) Annual Scientific Assembly.

The many issues that confront the clinician who treats patients with ischemic stroke, including those with diabetes, were addressed on September 28^th by Dan E. Brewer, MD, professor, department of family medicine, University of Tennessee School of Medicine, Knoxville, Tennessee.

In a comprehensive evidence-based review, Dr. Brewer stated that antihypertensive treatment is recommended for "the prevention of recurrent stroke and other vascular events in persons who have had an ischemic stroke, and who are beyond the hyperacute period."

He advised that the choice of specific antihypertensive drugs and targets "should be individualized, based on the published evidence as well as specific patient characteristics such as the presence of extracranial cerebrovascular occlusive disease, renal impairment, cardiac disease, and diabetes mellitus."

In patients with diabetes, "a more rigorous control of blood pressure and lipids should be considered," he said. Because ACEIs and angiotensin receptor blockers (ARBs) are more effective in reducing progression of renal disease, "they are recommended as first-choice medications for patients with diabetes," he noted.

Although an absolute target blood pressure level and reduction" are uncertain and should be individualized," benefit has been associated with an average reduction of approximately 10/5 mm Hg." Normal blood pressure levels have been defined as <120/80 mm Hg by the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.

In diabetic patients with an ischemic stroke or transient ischemic attach, glucose control to near-normoglycemic levels is advised to reduce microvascular complications, Dr. Brewer said. A statin is recommended to control hyperlipidemia in patients with coronary artery disease or with symptomatic atherosclerosis.

Lifestyle modifications are associated with reductions in blood pressure, and should be included as part of a comprehensive approach to antihypertensive therapy, Dr. Brewer noted. He advised that "clinicians should encourage weight management through an appropriate balance of caloric intake, physical activity, and behavioral counseling."


[Presentation title: Guidelines for the Treatment of Ischemic Stroke. Abstract 383]

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