Abstract
Background Elevated blood pressure (BP) in the acute phase of ischemic stroke is associated with heightened risk of early disability and death. However, whether BP-lowering in this setting is beneficial and the exact levels at which BP should be targeted remain unclear. This study aimed to evaluate the effect of nebivolol, olmesartan, and no-treatment on 24-hour BP in patients with hypertension during the acute poststroke period. Methods In a single-blind fashion, 60 patients with acute ischemic stroke and clinic systolic BP (SBP) 160–220 mmHg were randomized to nebivolol (5 mg/day), olmesartan (20 mg/day), or no-treatment between Day 4 and Day 7 of stroke onset. BP-lowering efficacy was assessed through 24-hour BP monitoring using the Mobil-O-Graph device (IEM, Germany). Results Between baseline and Day 7, significant reductions in 24-hour brachial SBP were noted with nebivolol and olmesartan, but not with no-treatment. Change from baseline (CFB) in 24-hour brachial SBP was not different between nebivolol and olmesartan groups (between-group difference: −3.4 mmHg; 95% confidence interval (CI): −11.2, 4.3), whereas nebivolol was superior to no-treatment in lowering 24-hour brachial SBP (between-group difference: −7.8 mmHg; 95% CI: −7.8 mmHg; 95% CI: −15.6, −0.1). Similarly, nebivolol and olmesartan equally lowered 24-hour aortic SBP (between-group difference: −1.9 mmHg; 95% CI: −10.1, 6.2). Nebivolol and olmesartan provoked similar reductions in 24-hour heart rate-adjusted augmentation index and pulse wave velocity. Conclusion This study suggests that during the acute phase of ischemic stroke, nebivolol is equally effective with olmesartan in improving 24-hour aortic pressure and arterial stiffness indices. ClinicalTrials.gov identifier number: NCT03655964.
Highlights
Unlike the established benefit of blood pressure (BP) control in primary and secondary prevention of stroke, management of acute BP elevation in the early poststroke period is an area of controversy [1]
A meta-analysis of observational studies showed that elevated 24-hour BP is closely associated with poor short, mid, and long-term functional outcome after an acute stroke [10], whereas clinic BP recorded on hospital admission is of no prognostic significance
Additional prespecified exclusion criteria of the study were the following: (i) chronic atrial fibrillation or other cardiac arrhythmia; (ii) contraindication or definite clinical indication for treatment with a β-blocker; (iii) contraindication or definite clinical indication for treatment with an angiotensin receptor blocker; (iv) known allergic reaction to nebivolol or olmesartan; (v) body mass index (BMI) >40 kg/m2; and (vi) deep coma or dysphagia that disabled the oral administration of study drugs
Summary
Elevated blood pressure (BP) in the acute phase of ischemic stroke is associated with heightened risk of early disability and death. Is study aimed to evaluate the effect of nebivolol, olmesartan, and no-treatment on 24-hour BP in patients with hypertension during the acute poststroke period. In a single-blind fashion, 60 patients with acute ischemic stroke and clinic systolic BP (SBP) 160–220 mmHg were randomized to nebivolol (5 mg/day), olmesartan (20 mg/day), or no-treatment between Day 4 and Day 7 of stroke onset. Between baseline and Day 7, significant reductions in 24-hour brachial SBP were noted with nebivolol and olmesartan, but not with no-treatment. Nebivolol and olmesartan lowered 24-hour aortic SBP (between-group difference: − 1.9 mmHg; 95% CI: − 10.1, 6.2). Is study suggests that during the acute phase of ischemic stroke, nebivolol is effective with olmesartan in improving 24-hour aortic pressure and arterial stiffness indices.
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