Top

Published in:

01-12-2013 | Stroke (C Sila, Section Editor)

Acute Hypertensive Response Management in Patients with Acute Stroke

Authors: Syeda L. Alqadri, Varun Sreenivasan, Adnan I. Qureshi

Published in: Current Cardiology Reports | Issue 12/2013

Abstract

Acute elevation in blood pressure (acute hypertensive response) is commonly observed in the early period of both ischemic and hemorrhagic stroke. The management of acute hypertensive response depends upon the underlying intracranial pathology. Management of acute hypertensive response has been the focus of many trials and studies such as the SCAST trial, CHHIPS trial, COSSACS trial, INTERACT, and ATACH trial, which are discussed here. However, there were many limitations to these trials including time of presentation, different pathophysiology of ischemic strokes versus hemorrhagic strokes, and patient related factors. Ongoing clinical trials which take these limitations into account include ENCHANTED trial, ATACH II trial, INTERACT 2 trial, and ENOS trial. The results of these trials are expected to modify current guidelines of acute stroke, both ischemic and hemorrhagic, and potentially improve clinical outcomes and quality of life.

Qureshi AI, Ezzeddine MA, Nasar A, Suri MF, Kirmani JF, Hussein HM, et al. Prevalence of elevated blood pressure in 563,704 adult patients with stroke presenting to the ED in the United States. Am J Emerg Med. 2007;25(1):32–8.PubMedCrossRef

Arboix A, Roig H, Rossich R, Martinez EM, Garcia-Eroles L. Differences between hypertensive and non-hypertensive ischemic stroke. Eur J Neurol. 2004;11(10):687–92.PubMedCrossRef

Patarroyo SX, Anderson C. Blood pressure lowering in acute phase of stroke: latest evidence and clinical implications. Ther Adv Chronic Dis. 2012;3(4):163–71. doi:10.1177/2040622312450183.PubMedCrossRef

Qureshi AI. Acute hypertensive response in patients with stroke: pathophysiology and management. Circulation. 2008;118(2):176–87.PubMedCrossRef

Orlandi G, Fanucchi S, Strata G, Pataleo L, Landucci Pellegrini L, Prontera C, et al. Transient autonomic nervous system dysfunction during hyperacute stroke. Acta Neurol Scand. 2000;102(5):317–21.PubMedCrossRef

Lattanzi S, Silvestrini M, Provinciali L. Elevated blood pressure in the acute phase of stroke and the role of Angiotensin receptor blockers. Int J Hypertens. 2013;2013:941783. doi:10.1155/2013/941783.PubMed

Sandset EC, Bath PM, Boysen G, Jatuzis D, Korv J, Luders S, et al. The angiotensin-receptor blocker candesartan for treatment of acute stroke (SCAST): a randomised, placebo-controlled, double-blind trial. Lancet. 2011;377(9767):741–50. doi:10.1016/S0140-6736(11)60104-9.PubMedCrossRef

Potter JF, Robinson TG, Ford GA, Mistri A, James M, Chernova J, et al. Controlling hypertension and hypotension immediately post-stroke (CHHIPS): a randomised, placebo-controlled, double-blind pilot trial. Lancet Neurol. 2009;8(1):48–56. doi:10.1016/S1474-4422(08)70263-1.PubMedCrossRef

Robinson TG, Potter JF, Ford GA, Bulpitt CJ, Chernova J, Jagger C, et al. Effects of antihypertensive treatment after acute stroke in the Continue or Stop Post-Stroke Antihypertensives Collaborative Study (COSSACS): a prospective, randomised, open, blinded-endpoint trial. Lancet Neurol. 2010;9(8):767–75. doi:10.1016/S1474-4422(10)70163-0.PubMedCrossRef

10.

Anderson CS, Huang Y, Wang JG, Arima H, Neal B, Peng B, et al. Intensive blood pressure reduction in acute cerebral haemorrhage trial (INTERACT): a randomised pilot trial. Lancet Neurol. 2008;7(5):391–9.PubMedCrossRef

11.

Anderson CS, Huang Y, Arima H, Heeley E, Skulina C, Parsons MW, et al. Effects of early intensive blood pressure-lowering treatment on the growth of hematoma and perihematomal edema in acute intracerebral hemorrhage: the Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT). Stroke. 2010;41(2):307–12. doi:10.1161/STROKEAHA.109.561795.PubMedCrossRef

12.

•• Qureshi A, Palesch Y. Expansion of recruitment time window in antihypertensive treatment of acute cerebral hemorrhage (ATACH) II trial. J Vasc Interv Neurol. 2012;5(supp):6–9. This is an ongoing trial which evaluates the efficacy of early, intensive, antihypertensive treatment using intravenous nicardipine initiated within 3 h of onset of intracerebral hemorrhage.

13.

• Delcourt C, Huang Y, Wang J, Heeley E, Lindley R, Stapf C, et al. The second (main) phase of an open, randomised, multicentre study to investigate the effectiveness of an intensive blood pressure reduction in acute cerebral haemorrhage trial (INTERACT2). Int J Stroke. 2010;5(2):110–6. doi:10.1111/j.1747-4949.2010.00415. This is the main phase trial which evaluates early intensive blood pressure lowering and effects on hematoma expansion within 6 h of onset of intracerebral hemorrhage.PubMedCrossRef

14.

Glyceryl trinitrate vs. control, and continuing vs. stopping temporarily prior antihypertensive therapy, in acute stroke: rationale and design of the Efficacy of Nitric Oxide in Stroke (ENOS) trial (ISRCTN99414122). Int J Stroke. 2006;1(4):245–9. doi:10.1111/j.1747-4949.2006.00059.x.

15.

Qureshi AI, Palesch YY, Martin R, Novitzke J, Cruz-Flores S, Ehtisham A, et al. Effect of systolic blood pressure reduction on hematoma expansion, perihematomal edema, and 3-month outcome among patients with intracerebral hemorrhage: results from the antihypertensive treatment of acute cerebral hemorrhage study. Arch Neurol. 2010;67(5):570–6. doi:10.1001/archneurol.2010.61.PubMedCrossRef

16.

Antihypertensive treatment of acute cerebral hemorrhage. Crit Care Med. 2010;38(2):637–48. doi:10.1097/CCM.0b013e3181b9e1a5.

17.

Anderson C. Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED). 2011. http://clinicaltrials.gov/show/NCT01422616. Accessed 06/20/2013.

18.

Jauch EC, Saver JL, Adams Jr HP, Bruno A, Connors JJ, Demaerschalk BM, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(3):870–947. doi:10.1161/STR.0b013e318284056a.PubMedCrossRef

19.

Broderick JP, Adams Jr HP, Barsan W, Feinberg W, Feldmann E, Grotta J, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke. 1999;30(4):905–15.PubMedCrossRef

20.

Qureshi AI, Tuhrim S, Broderick JP, Batjer HH, Hondo H, Hanley DF. Spontaneous intracerebral hemorrhage. N Engl J Med. 2001;344(19):1450–60. doi:10.1056/NEJM200105103441907.PubMedCrossRef

21.

Jung SY, Choi NK, Kim JY, Chang Y, Song HJ, Lee J, et al. Short-acting nifedipine and risk of stroke in elderly hypertensive patients. Neurology. 2011;77(13):1229–34. doi:10.1212/WNL.0b013e318230201a.PubMedCrossRef

Title: Acute Hypertensive Response Management in Patients with Acute Stroke
Authors: Syeda L. Alqadri
Varun Sreenivasan
Adnan I. Qureshi
Publication date: 01-12-2013
Publisher: Springer US
Published in: Current Cardiology Reports / Issue 12/2013
Print ISSN: 1523-3782
Electronic ISSN: 1534-3170
DOI: https://doi.org/10.1007/s11886-013-0426-7

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The STEP trials

Springer Medicine

Acute Hypertensive Response Management in Patients with Acute Stroke

Abstract

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 12/2013

Medical Treatment of Hypertension in Patients with Heart Failure with Preserved Ejection Fraction

Small Vessel Disease and Memory Loss: What the Clinician Needs to Know to Preserve Patients’ Brain Health

Cerebral Microbleeds and Macrobleeds: Should They Influence Our Recommendations for Antithrombotic Therapies?

The Growing Problem of Stroke among Young Adults

The Challenge of Stroke Prevention with Intracranial Arterial Stenosis

Sudden Unexpected Death in Epilepsy or Voodoo Heart: Analysis of Heart/Brain Connections

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page