Savitz said the study goes part of the way in settling an issue that arose in the 1990s, when tPA was shown to be effective in the first hours after a stroke. But more trials are needed on the treatment of high blood pressure in the hours after a stroke, he said.
"How aggressive should you be in doing it?" he said. "If you lower it too much, you can do damage, because the brain depends on blood pressure to supply it with blood."
Dr. Irene Katzan, a vascular neurologist at the Cleveland Clinic, called the new findings "very intriguing," but she added, "I don't think the data are enough to warrant a change in practice."
At the Cleveland Clinic, the practice is to try to bring down elevated blood pressure, but not usually as aggressively as done in the Texas study, she said.
"The guidelines are straightforward in regard to blood pressure control," Katzan said. "We follow what is recommended for a blood pressure of 185 over 110. Some medication is fine, but aggressive use of blood pressure medication poses something of a contraindication to therapy."
But the Texas report could herald a change in treatment, Katzan said. The Houston group is foremost in stroke treatment and, Katzan added, "I think that other future reports that are similar to this could be used potentially to alter practice," she said.
Learn more about the use of tPA in stroke patients from the American Heart Association.
SOURCES: Sean I. Savitz, M.D., co-director, Stroke Center, University of Texas Medical School at Houston; Irene Katzan, M.D., vascular neurologist, Cleveland Clinic; September 2008, Archives of Neurology
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