Abstract
BackgroundElevated blood pressure (BP) levels are common following acute stroke. However, there is considerable uncertainty if and when antihypertensive therapy should be initiated.MethodEconomic evaluation alongside a double-blind randomised placebo-controlled trial (National Research Register Trial Number N0484128008) of 112 hypertensive patients receiving an antihypertensive regimen (labetalol or lisinopril) within 36 hours post stroke versus 59 receiving placebo. Outcomes were incremental cost per incremental: QALY, survivor, and patient free from death or severe disability (modified Rankin scale score < 4) at three months and 14 days post stroke.ResultsActively treated patients on average had superior outcomes and lower costs than controls at three months. From the perspective of the acute hospital setting, there was a 96.5% probability that the incremental cost per QALY gained at three months is below £30,000, although the probability may be overstated due to data limitations.ConclusionAntihypertensive therapy when indicated immediately post stroke may be cost-effective compared with placebo from the acute hospital perspective. Further research is required to confirm both efficacy and cost-effectiveness and establish whether benefits are maintained over a longer time horizon.
Highlights
Elevated blood pressure (BP) levels are common following acute stroke
From the perspective of the acute hospital setting, there was a 96.5% probability that the incremental cost per Quality Adjusted Life Year (QALY) gained at three months is below £30,000, the probability may be overstated due to data limitations
Antihypertensive therapy when indicated immediately post stroke may be cost-effective compared with placebo from the acute hospital perspective
Summary
Elevated blood pressure (BP) levels are common following acute stroke. 52,000 patients experience first stroke [1], and 135,000 experience first or recurrent stroke in England and Wales each year [2]. It is the third biggest cause of death and the most important single cause of severe adult disability [3]. The acute management of post-stroke BP changes is a matter of some debate, with considerable differences of opinion on when to initiate antihypertensive therapy [17]. A Cochrane review of BP manipulation following stroke concluded that there was insufficient evidence to evaluate the effect of changes on patient outcomes [18]
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