FRIDAY, Feb. 11 (HealthDay News) -- Giving medication to lower
blood pressure in hypertensive stroke patients appears to have no
benefit and might even be harmful, says a new study that seems to
confirm current treatment guidelines.
"Clinicians should not be prescribing blood-pressure-lowering drugs within the first week of acute stroke in routine practice, but researchers should continue to evaluate the safety and effectiveness of other interventions for blood pressure in acute stroke," said Dr. Graeme J. Hankey, head of the Stroke Unit at Royal Perth Hospital in Australia, who is familiar with the study.
Researchers looked at the effect of the blood pressure-lowering
drug candesartan on about 1,000 acute stroke patients. Their
findings are published online Feb. 11 in
The Lancet to coincide with presentation of the study at the
International Stroke Conference in Los Angeles.
When added to the results of 10 previous trials, this study
indicates that lowering blood pressure in the first week after
acute stroke has no overall benefit on subsequent outcome, said
Hankey, author of an accompanying journal editorial.
Doctors have been unsure how to treat high blood pressure in
acute stroke patients, and current guidelines recommend leaving it
For the study, a multicenter team led by Dr. Eivind Berge from
Oslo University Hospital Ulleval in Norway randomly assigned 2,029
acute stroke patients to take candesartan (Atacand) or a placebo.
Candesartan belongs to a family of drugs called
Over a week, the drug significantly lowered the blood pressure
of patients receiving it. However, over six months no difference
emerged between the two groups in the risk of death, heart attack
or stroke, the researchers found.
Moreover, patients taking the drug tended to have poorer
outcomes, compared with patients receiving placebo, although this
finding was not statistically significant, Berge's group says.
Among those taking candesartan, nine had symptoms associated
with low blood pressure, compared with five patients taking
placebo. In addition, 18 patients taking candesartan suffered
kidney failure, compared with 13 patients receiving placebo, the
Berge's team reviewed other studies, which also showed that
lowering blood pressure in acute stroke patients had no
"Other trials are ongoing, but until these trials have been completed we see no place for routine blood pressure-lowering treatment in the acute phase of stroke," the researchers conclude.
Commenting on the study, Dr. Larry B. Goldstein, professor of
neurology and director of the Duke Stroke Center at Duke University
Medical Center , said that "the optimal treatment of elevated blood
pressure in the setting of acute ischemic stroke has been uncertain
because of a lack of adequate controlled trials."
Current guidelines recommend that blood pressure should
generally not be lowered during the acute phase of ischemic stroke,
because doing so might compromise circulation to the damaged brain.
"This study supports these existing recommendations," he said.
For more information on stroke, visit the
U.S. National Library of Medicine.
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