Association between antihypertensive treatment, blood pressure variability, and stroke severity and outcomes in acute ischemic stroke

• Published in: Journal of clinical neuroscience Vol. 125; pp. 51 - 58
• Main Authors: Karagiannaki, Anastasia, Kakaletsis, Nikolaos, Chouvarda, Ioanna, Dourliou, Vasiliki, Milionis, Haralampos, Savopoulos, Christos, Ntaios, George
• Format: Journal Article
• Language: English
• Published: Scotland Elsevier Ltd 01.07.2024
• Subjects: Acute ischemic stroke; Ambulatory blood pressure monitoring; Antihypertensive; Blood pressure variability; Antihypertensive; Blood pressure variability; Acute ischemic stroke; Ambulatory blood pressure monitoring
• ISSN: 0967-5868; 1532-2653
• DOI: 10.1016/j.jocn.2024.05.014

•Vasodilators and beta blockers are the antihypertensive medications more commonly continued after stroke onset.•Administration of beta blockers and ACEIs, both before and after the stroke, was linked to increased DBP variability.•Prior use of ARBs and vasodilators correlated with higher SBP variability and lower daytime SBP/DBP levels, respectively.•Changes in AHT use, (switching, continuation, or discontinuation), after stroke onset did not impact patient outcomes.•Patients on CCBs pre-stroke experienced less severe strokes, and patients with prior ARB therapy showed improved outcomes. The management of blood pressure (BP) and the role of antihypertensive medications (AHT) in acute ischemic stroke (AIS) remain uncertain. This study aimed to investigate the impact of pre- and intra-stroke AHT use on systolic (SBP), diastolic (DBP), and blood pressure variability (BPV). A post-hoc analysis was conducted on 228 AIS patients from the PREVISE study. All patients underwent 24-hour ambulatory blood pressure monitoring within 48 h of symptom onset. Clinical and laboratory data, as well as AHT details, were recorded. Mean BP parameters and BPV for SBP and DBP were computed. The study endpoint was 3-month mortality. The majority of stroke patients (84.2%) were already taking AHTs. Beta blockers and ACE inhibitors use before and after stroke were linked to higher DBP variability. Prior angiotensin receptor blockers (ARBs) and vasodilators use correlated with increased SBP variability and lower daytime SBP/DBP levels, respectively. The continuation, discontinuation, or change of AHTs after stroke onset did not significantly affect outcomes. Patients under AHTs during AIS exhibited reduced mortality, with those previously using calcium channel blockers experiencing less severe strokes, and those previously using ARBs showing better outcomes at three months. These findings advocate for personalized BP management in AIS, based on a patient's antihypertensive history. These insights could enhance treatment efficacy, guide research, and improve care for acute ischemic stroke patients.