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Antihypertensives Are Administered Selectively in Emergency Department Patients with Subarachnoid Hemorrhage.
MedLine Citation:
PMID:  22494701     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Elevated blood pressure is common in patients with acute subarachnoid hemorrhage (SAH). American Heart Association guidelines do not specify a blood pressure target, but limited data suggest that systolic blood pressure (SBP) ≥160 mmHg is associated with increased risk of rebleeding and neurologic decline. In a population-based study, we determined the frequency of antihypertensive therapy in emergency department (ED) patients with SAH and the proportion of those patients with SBP ≥160 mmHg who received this therapy. In 2005, nontraumatic SAH cases were retrospectively ascertained at 16 hospitals in our region by screening for International Classification of Diseases Ninth Revision diagnostic codes 430-436. Blood pressure was recorded at ED presentation and also before and after any treatment with antihypertensives. Hypotension was defined as SBP <100 mmHg. The Mann-Whitney U test and χ(2) test were used for comparisons. Our cohort comprised 82 patients with SAH presenting to an ED; 4 patients were excluded. The median age of the included patients was 54 years, 74.4% were female, 29.5% were black, and 31 (39.7%) had SBP ≥160 mmHg. Antihypertensive therapy was given to 22 of 31 patients (70.9%) with SBP ≥160 mmHg and to 4 of 47 patients (8.5%) with SBP <160 mmHg. No patients became hypotensive after receiving treatment. Age, sex, Glascow Coma Scale score, and National Institutes of Health Stroke Scale score were similar between treated and untreated patients. In the absence of definitive evidence, current blood pressure management in local EDs appears reasonable. Further studies of blood pressure management in acute SAH are warranted.
Authors:
Virginia Culyer; Erin McDonough; Christopher J Lindsell; Kathleen Alwell; Charles J Moomaw; Brett M Kissela; Matthew L Flaherty; Pooja Khatri; Daniel Woo; Simona Ferioli; Joseph P Broderick; Dawn Kleindorfer; Opeolu Adeoye
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-4-10
Journal Detail:
Title:  Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association     Volume:  -     ISSN:  1532-8511     ISO Abbreviation:  -     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-4-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9111633     Medline TA:  J Stroke Cerebrovasc Dis     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 National Stroke Association. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Emergency Medicine, University of Cincinnati Neuroscience Institute, University of Cincinnati, Cincinnati, Ohio.
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