After Stroke, TPA Therapy OK Even For Those With Hypertension

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Main Category: Stroke
Also Included In: Hypertension
Article Date: 09 Sep 2008 - 0:00 PDT

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According to a paper published in the September issue of Archives of Neurology, anti-clotting therapy does not seem to increase the risk of bleeding or other adverse outcomes in patients who need therapy to reduce their blood pressure after suffering from stroke.

Acute ischemic stroke occurs when a blood clot blocks blood flow to the brain. Patients with this condition also usually have hypertension (high blood pressure). Author Sheryl Martin-Schild, M.D., Ph.D. (formerly of the University of Texas Health Sciences Center at Houston and currently at Tulane University Health Sciences Center, New Orleans) and colleagues write that, "As many as 10 percent of otherwise eligible patients do not receive tissue plasminogen activator (tPA), the only proved therapy for acute ischemic stroke, because of severely elevated blood pressure." Previous guidelines, write the authors, "Recommended against giving tPA to treat acute ischemic stroke when aggressive measures (such as continuous infusion or more than two infusions of anti-hypertensive agents) are required to maintain blood pressure lower than 185/110 millimeters of mercury."

To further analyze the relationship between antihypertensive treatments and adverse events in stroke victims, the researchers studied the medical records of 178 patients with acute ischemic stroke who received intravenous tPA within three hours. Fifty of the patients needed a second therapy to lower blood pressure before tPA treatment could begin, including 24 (48%) who received the drug nicardipine either alone or together with the drug labetalol.

"We observed several important differences between patients who required blood pressure-lowering treatment and those who did not," write the researchers. "They had more severe strokes and their blood glucose concentration was higher, predicting they would have a worse outcome if all other factors were equal. As expected, they more frequently had a history of hypertension."

The investigators then statistically controlled for factors such as age, baseline stroke severity, and blood glucose levels. They still found no differences in adverse events, poor outcomes, or stroke severity score at discharge between patients who received antihypertensive treatments and those who did not.

"Overall, the results of the present study provide the first experimental support for the revised American Heart Association guidelines allowing tPA therapy in patients requiring aggressive blood pressure management and also provides support for the use of nicardipine in patients with acute ischemic stroke who are eligible for thrombolytic therapy," they conclude. "Aggressive control of severely elevated blood pressure is feasible and should not automatically exclude otherwise eligible patients with acute ischemic stroke from receiving thrombolytic therapy."

Aggressive Blood Pressure-Lowering Treatment Before Intravenous Tissue Plasminogen Activator Therapy in Acute Ischemic Stroke
Sheryl Martin-Schild; Hen Hallevi; Karen C. Albright; Aslam M. Khaja; Andrew D. Barreto; Nicole R. Gonzales; James C. Grotta; Sean I. Savitz
Archives of Neurology (2008). 65(9):1174-1178.
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Written by: Peter M Crosta
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