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No Benefit to Lowering Blood Pressure in Acute Stroke: Study

By Steven Reinberg
HealthDay Reporter

FRIDAY, Feb. 11 (HealthDay News) -- Giving medication to lower blood pressure in hypertensive stroke patients appears to have no benefit and might even be harmful, says a new study that seems to confirm current treatment guidelines.

"Clinicians should not be prescribing blood-pressure-lowering drugs within the first week of acute stroke in routine practice, but researchers should continue to evaluate the safety and effectiveness of other interventions for blood pressure in acute stroke," said Dr. Graeme J. Hankey, head of the Stroke Unit at Royal Perth Hospital in Australia, who is familiar with the study.

Researchers looked at the effect of the blood pressure-lowering drug candesartan on about 1,000 acute stroke patients. Their findings are published online Feb. 11 in The Lancet to coincide with presentation of the study at the International Stroke Conference in Los Angeles.

When added to the results of 10 previous trials, this study indicates that lowering blood pressure in the first week after acute stroke has no overall benefit on subsequent outcome, said Hankey, author of an accompanying journal editorial.

Doctors have been unsure how to treat high blood pressure in acute stroke patients, and current guidelines recommend leaving it alone.

For the study, a multicenter team led by Dr. Eivind Berge from Oslo University Hospital Ulleval in Norway randomly assigned 2,029 acute stroke patients to take candesartan (Atacand) or a placebo. Candesartan belongs to a family of drugs called angiotensin-receptor blockers.

Over a week, the drug significantly lowered the blood pressure of patients receiving it. However, over six months no difference emerged between the two groups in the risk of death, heart attack or stroke, the researchers found.

Moreover, patients taking the drug tended to have poorer outcomes, compared with patients receiving placebo, although this finding was not statistically significant, Berge's group says.

Among those taking candesartan, nine had symptoms associated with low blood pressure, compared with five patients taking placebo. In addition, 18 patients taking candesartan suffered kidney failure, compared with 13 patients receiving placebo, the researchers note.

Berge's team reviewed other studies, which also showed that lowering blood pressure in acute stroke patients had no benefit.

"Other trials are ongoing, but until these trials have been completed we see no place for routine blood pressure-lowering treatment in the acute phase of stroke," the researchers conclude.

Commenting on the study, Dr. Larry B. Goldstein, professor of neurology and director of the Duke Stroke Center at Duke University Medical Center , said that "the optimal treatment of elevated blood pressure in the setting of acute ischemic stroke has been uncertain because of a lack of adequate controlled trials."

Current guidelines recommend that blood pressure should generally not be lowered during the acute phase of ischemic stroke, because doing so might compromise circulation to the damaged brain. "This study supports these existing recommendations," he said.

More information

For more information on stroke, visit the U.S. National Library of Medicine.

SOURCES: Larry B. Goldstein, M.D., professor, neurology, and director, Duke Stroke Center, Duke University Medical Center, Durham, N.C.; Graeme J. Hankey, M.D., consultant neurologist and head, Stroke Unit, Royal Perth Hospital and University of Western Australia, Perth; Feb. 11, 2011, The Lancet, online

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