Hypertension in acute ischaemic stroke: to treat or not to treat.

Abstract

The reasons for not treating hypertension could be the risk of reducing cerebral blood flow (CBF) which may induce additional cerebral damage in the so-called ischaemic "penumbra". Hypertensive patients have altered autoregulation. A severe hypertension (over 230/120 mmHg) may lead to further damage by cerebral edema which asks for antihypertensive therapy. An antihypertensive therapy was applied in 81 patients within the 72 hours interval from acute ischaemic stroke (AIS) onset. In 42 patients, the antihypertensive treatment was discontinued after the 72-hour interval (the therapy with nifedipine in daily doses of 10-20 mg was not considered as hypotensive). We compared as end points: the survival, death, modified Rankin Scale (mRS). There were no statistically significant differences between end points of patients who discontinued (group C) and those who maintained (group T) the antihypertensive therapy. The mean value of blood pressure was higher in patients who maintained antihypertensive therapy (p < 0.001 for systolic blood pressure (BP); p = 0.001593 for diastolic blood pressure). The mean value of age in patients in whom antihypertensive therapy was discontinued was higher than that found in patients who maintained antihypertensive therapy (p < 0.05).