PP.29.33] ANTIHYPERTENSIVE TREATMENT AND OUTCOME IN PATIENTS WITH ACUTE STROKE FROM BULGARIAN IN-HOSPITAL POPULATION

Abstract

Objective: High blood pressure (BP) is considered an independent poor prognostic factor in acute stroke, but treating hypertension in the acute phase of stroke is a controversial issue. The aim of the study was to analyze the antihypertensive treatment, BP dynamics and outcome in patients with hypertensive crisis (HC) and acute ischemic (IS) or hemorrhagic stroke (HS). Design and method: 108 randomly selected in-hospital acute stroke patients (54 men and 54 women - 70 persons with IS and 38 with HS, accompanied by HC at admission (systolic blood pressure /SBP/ >180 mm Hg and /or diastolic blood pressure (DBP) >120 mm Hg). Antihypertensive medication, BP dynamics, and cliniical status were analyzed. Results: Almost all patients received (venous and/or oral) antihypertensive therapy and BP was reduced in the course of treatment. Drugs from all antihypertensive classes were administered. The most common agents were clonidine and furosemide (parenterally or orally), enalapril, amlodipin and bisoprolol (per os). Most of the patients received combined antihypertensive therapy with more than 2 drugs. Mean number of oral agents was 2,21 (2,5 for IS and 1,76 for HS /p = 0,006/). Patients with HS received significantly more venous medication. BP reduction was more pronounced in the first 24 hours (about 25% drop); afterwards smoother. Persons with HS demonstrated significantly higher levels of BP than those with IS at admission and the first hours. Patients with clinical improvement were with significantly lower levels of BP at baseline, 12th hour, third day, and at dismission than those with deterioration. Higher values of BP in the patients who died in hospital (4 with IS and 14 with HS) than those dismissed (significant in the first hours in HS and at the 3rd and 4th day in IS) were observed. Conclusions: Persistent high BP in acute stroke might be associated with worse prognosis. Differences between IS and HS in BP dynamics exist. Overall patients with HS and more severe stroke tend to have higher BP levels and worse outcome (no improvement, deterioration or death). High BP in the acute phase of stroke should be reduced carefully especially in IS patients.