Document Detail


Overuse of antihypertensives in patients with acute ischemic stroke.
MedLine Citation:
PMID:  17195418     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The Stroke Council of the American Heart Association/American Stroke Association (AHA/ASA) recommends conservative management of hypertension (HTN) during acute ischemic stroke (AIS), although clinicians often manage blood pressure more aggressively. Our hypothesis was that aggressive management of HTN in patients with AIS is associated with hypotensive events and worsened neurologic outcomes. METHODS: The study was a retrospective, observational cohort of patients who were admitted to the hospital with AIS. Classification of neurologic outcomes was based on nurses' neurologic assessments and were categorized as "worsened," "stayed the same," or "improved." The accuracy of these assessments was verified by review of physician's progress notes. Management of arterial HTN was recorded in all patients. RESULTS: Fifty medical records of patients with AIS who met inclusion criteria were reviewed. While only 22% of patients met the AHA/ASA criteria for hypertension treatment, 98% of the cohort were given antihypertensive therapy. Relative hypotension occurred in 64% of treated patients. Absolute hypotension associated with antihypertensive medications was uncommon but did occur in 2 of 15 patients who experienced neurologic worsening (13%), in 1 of 28 (3%) of patients who stayed the same, and in none of those who improved. Blood pressure was reduced excessively in all 11 of the patients who met AHA/ASA guidelines for treatment. CONCLUSIONS: Adherence to AHA/ASA guidelines for HTN management during AIS was poor. Initiation or intensification of antihypertensive drugs was not associated with worsened neurologic outcomes. Furthermore, relative hypotension, absolute hypotension and excessive reductions in blood pressure were not associated with worsened neurologic outcomes.
Authors:
Matthew Underwood; Bob L Lobo; Christopher Finch; James Wang
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Southern medical journal     Volume:  99     ISSN:  0038-4348     ISO Abbreviation:  South. Med. J.     Publication Date:  2006 Nov 
Date Detail:
Created Date:  2007-01-01     Completed Date:  2007-01-23     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0404522     Medline TA:  South Med J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1230-3     Citation Subset:  AIM; IM    
Affiliation:
Department of Pharmacy, Methodist University Hospital, 1265 Union Avenue, Memphis, TN 38104, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Antihypertensive Agents / therapeutic use*
Blood Pressure
Brain Ischemia / epidemiology*,  physiopathology
Female
Guideline Adherence
Humans
Hypertension / drug therapy,  epidemiology*
Male
Physician's Practice Patterns
Practice Guidelines as Topic
Retrospective Studies
Stroke / epidemiology*,  physiopathology
Chemical
Reg. No./Substance:
0/Antihypertensive Agents
Comments/Corrections
Comment In:
South Med J. 2006 Nov;99(11):1207-8   [PMID:  17195413 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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