CHOICE OF ANTIHYPERTENSIVE AGENTS IN ANTIHYPERTENSIVEREGISTRY IN ACUTE STROKE LIPPO VILLAGE (ARAS-LV)

Abstract

Background: Raised blood pressure in patients with acute stroke is one of the major unresolved issues in acute stroke management. Current AHA/ASA guidelines suggest cautious lowering of BP by no more that 20% in the first 24 hours. Large studies comparing various antihypertensives are not available. Objectives: This study aims to evaluate performance between various antihypertensive agentsin lowering blood pressure during acute stroke phase. Methods: Patients (n = 33) with acute stroke (< five days) and elevated blood pressure who didn’t recieve antithrombolytic treatment in or craniectomy is sorted from theARAS-LV, ongoing prospective, single center, observational study, since Febuary 2014. Pateintsreceive random antihypertensive treatment either oral (single or combination) namely amlodipine, candesartan, captorpil, candesartan/amlodipine or intravenous (nicardipine) antihypertensive medication according to clinician preference aimed at lowering blood pressure by 10%–20% within 24 hour. Results: Mean systolic blood pressure was reduced from 185,03 mmHg to 151,18 mmHg (−18,29%) in 24 hour while mean diastolic blood pressure was reduction 109,33 mmHg to 88,36 (−19,18%). Mean arterial pressure (MAP) reduction within the first 24 hours was from 134,57 to 109,30 (−17,07%). There was no significant difference between oral (single or combination) or intravenous in reduction in 24 hour of systolic blood pressure (p = 0.873), diastolic blood pressure (p = 0.593), and MAP (p = 0.738) Conclusion: Mean systolic, diastolic and arterial pressure could be reduced within 24 hours either using oral or intravenous antihypertensive agents within AHA/ASA safe range (≤ 20%). This study shows there is no superior antihypertensive agent in reducing blood presure within 24 hours in acute stroke.