Antihypertensive treatment strategy and blood pressure control in patients with essential hypertension complicated by ischemic hemispheric stroke
DOI:
https://doi.org/10.14739/2310-1210.2019.3.168957Keywords:
arterial hypertension, stroke, blood pressure, arterial pressure.Abstract
The aim was to study the effectiveness of antihypertensive therapy in essential hypertensives in the acute phase of ischemic hemispheric stroke.
Material and methods. The first group included 18 patients (65 (59; 69) years, 61 % male) with arterial hypertension (AH) in the acute phase of ischemic hemispheric stroke who received antihypertensive monotherapy. The second group included 14 AH patients (aged 61 (56; 71) years, 57 % male) in the acute phase of ischemic hemispheric stroke who received combination antihypertensive treatment. The effectiveness of antihypertensive therapy was evaluated on day 21 (12, 30) of the stroke onset by “office” blood pressure (BP) measurement. In order to identify the covariates associated with the probability of target BP level achieving at the end of the hospital period, binary logistic regression models were used.
Results. 61 % of patients (11/18) achieved the target BP level with monotherapy strategy and 64 % (9/14) achieved the target BP level with combination antihypertensive therapy, insignificant difference (P = 0.854). 24-hour systolic, diastolic, pulse, mean arterial pressure (MAP), calculated by empirical and Wezler–Böger formulas, were slightly higher in the group of patients receiving combined antihypertensive drugs, however, there was no significant difference (P = 0.262; P = 0.356; P = 0.880; P = 0.262; P = 0.279, respectively). Meanwhile, the groups were differed in the daytime MAP level calculated by two formulas (P = 0.032 and P = 0.040, respectively). According to the ROC-analysis, the cut-offs of daytime MAP was 102.4 mm Hg and 104.9 mm Hg, respectively. In the logistic regression analysis, the multivariate model adjusted for age, sex and status of diabetes mellitus, the monocomponent scheme (angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB)) was associated with the target BP level achievement in AH patients in the acute phase of ischemic hemispheric stroke (OR: 18.61; (DI: 3.36; 103.14), P = 0.001).Conclusions. 63 % of AH patients treated with the first-line drugs in the acute phase of ischemic hemispheric stroke achieved the target BP level. Monocomponent antihypertensive therapy prescribed at the end of the acute hypertensive reaction in AH patients was as effective as combined strategy in achieving the target BP level by “office” measurements in the 2–4 weeks of the disease. The multivariate model adjusted for age, sex and status of diabetes mellitus which associated with target BP level achievement in AH patients in the acute phase of ischemic hemispheric stroke included a monocomponent scheme (ACEi or ARB). The cut-offs of daytime MAP calculated by empirical and Wezler–Böger formulas were 102.4 mm Hg and 104.9 mm Hg, respectively. The daytime MAP (24-hour BP monitoring) was the only parameter that was statistically higher in the group of combined treatment and so, can be the criterion for the combination therapy prescription in AH patients in the acute phase of ischemic hemispheric stroke.
References
Williams, B., Mancia, G., Spiering, W., Agabiti, R. E., Azizi, M., Burnier, M., et al. (2018) 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J, 39(33), 3021–3104. doi: 10.1093/eurheartj/ehy339
AlSibai, A., & Qureshi, A. (2016) Management of acute hypertensive response in patients with ischemic stroke. Neurohospitalist, 6(3), 122–129. doi: 10.1177/1941874416630029
Ministerstva okhorony zdorov’ia Ukrainy (2012) Unifikovanyi klinichnyi protocol medychnoi dopomogy: ischemichnyi insult (ekstrena, pervynna, vtorynna (spetsializovana) medychna dopomoha, medychna reabilitatsiia [Clinical protocol for medical ischemic stroke (emergency, primary, secondary (specialized) medical care, medical rehabilitation)]. Reteieved from http://old.moz.gov.ua/ua/portal/dn_20120803_602.html [in Ukrainian].
Kovalenko V. M., et al. (Eds) (2016) Sertsevo-sudynni zakhvoriuvannia. Klasifikatsiia, standarty diahnostyky ta likuvannia [Cardiovascular diseases: Classification, practical protocols of diagnosis and treatment]. Kyiv: Morion [in Ukrainian].
Parati, G., Stergiouc, G., O’Briend, Е. Asmar, R., Beilin, L., Bilo, G., et al. (2014) European society of hypertension practice guidelines for ambulatory blood pressure monitoring. J Hypertens, 32(7), 1359–136. doi: 10.1097/HJH.0000000000000221
Papaioannou, T., Protogerou, A., Vrachatis, D., Konstantonis, G., Aissopou, E., Argyris, A., et al. (2016) Mean arterial pressure values calculated using seven different methods and their associations with target organ deterioration in a single-center study of 1878 individuals. Hypertension Research, 39(9), 640–647. doi: 10.1038/hr.2016.41
He, J., Zhang, Y., Xu, T., Wang, D., Sun, Y., Chen, C. S., et al. (2014) Effects of immediate blood pressure reduction on death and major disability in patients with acute ischemic stroke: the CATIS randomized clinical trial. JAMA, 311(5), 479–489. doi: 10.1001/jama.2013.282543
Robinson, T., Potter, J., Ford, G., Bulpitt, C. J., Chernova, J., Jagger, C., et al. (2010) Effects of antihypertensive treatment after acute stroke in the Continue or Stop Post-Stroke Antihypertensives Collaborative Study (COSSACS): a prospective, randomised, open, blinded-endpoint trial. Lancet Neurol, 9(8), 767–75. doi: 10.1016/S1474-4422(10)70163-0
Bath, P. M., Martin, R. H., Palesch, Y., Cotton, D., Yusuf, S., Sacco, R., et al. (2009) Effect of telmisartan on functional outcome, recurrence, and blood pressure in patients with acute mild ischemic stroke: a PRoFESS subgroup analysis. Stroke, 40(11), 3541–3546. doi: 10.1161/STROKEAHA.109.555623
Sandset, E. C., Bath, P. M., Boysen, G., Cotton, D., Yusuf, S., Sacco, R., et al. (2011) The angiotensin-receptor blocker candesartan for treatment of acute stroke (SCAST): a randomised, placebo-controlled, double-blind trial. Lancet, 377(9767), 741–750. doi: 10.1016/S0140-6736(11)60104-9
Bath, P., & Krishnan, K. (2014) Interventions for deliberately altering blood pressure in acute stroke. Cochrane Database Syst Rev, 10. CD000039. doi: 10.1002/14651858.
Downloads
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)