Antihypertensive treatment strategy and blood pressure control in patients with essential hypertension complicated by ischemic hemispheric stroke

Abstract

Abstract The aim was to study the effectiveness of antihypertensive therapy in essential hypertensives in the acute phase of ischemic hemispheric stroke. Material and methods. The first group included 18 patients (65 (59; 69) years, 61 % male) with arterial hypertension (AH) in the acute phase of ischemic hemispheric stroke who received antihypertensive monotherapy. The second group included 14 AH patients (aged 61 (56; 71) years, 57 % male) in the acute phase of ischemic hemispheric stroke who received combination antihypertensive treatment. The effectiveness of antihypertensive therapy was evaluated on day 21 (12, 30) of the stroke onset by “office” blood pressure (BP) measurement. In order to identify the covariates associated with the probability of target BP level achieving at the end of the hospital period, binary logistic regression models were used. Results. 61 % of patients (11/18) achieved the target BP level with monotherapy strategy and 64 % (9/14) achieved the target BP level with combination antihypertensive therapy, insignificant difference (P = 0.854). 24-hour systolic, diastolic, pulse, mean arterial pressure (MAP), calculated by empirical and Wezler–Böger formulas, were slightly higher in the group of patients receiving combined antihypertensive drugs, however, there was no significant difference (P = 0.262; P = 0.356; P = 0.880; P = 0.262; P = 0.279, respectively). Meanwhile, the groups were differed in the daytime MAP level calculated by two formulas (P = 0.032 and P = 0.040, respectively). According to the ROC-analysis, the cut-offs of daytime MAP was 102.4 mm Hg and 104.9 mm Hg, respectively. In the logistic regression analysis, the multivariate model adjusted for age, sex and status of diabetes mellitus, the monocomponent scheme (angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB)) was associated with the target BP level achievement in AH patients in the acute phase of ischemic hemispheric stroke (OR: 18.61; (DI: 3.36; 103.14), P = 0.001). Conclusions. 63 % of AH patients treated with the first-line drugs in the acute phase of ischemic hemispheric stroke achieved the target BP level. Monocomponent antihypertensive therapy prescribed at the end of the acute hypertensive reaction in AH patients was as effective as combined strategy in achieving the target BP level by “office” measurements in the 2–4 weeks of the disease. The multivariate model adjusted for age, sex and status of diabetes mellitus which associated with target BP level achievement in AH patients in the acute phase of ischemic hemispheric stroke included a monocomponent scheme (ACEi or ARB). The cut-offs of daytime MAP calculated by empirical and Wezler–Böger formulas were 102.4 mm Hg and 104.9 mm Hg, respectively. The daytime MAP (24-hour BP monitoring) was the only parameter that was statistically higher in the group of combined treatment and so, can be the criterion for the combination therapy prescription in AH patients in the acute phase of ischemic hemispheric stroke.

Keywords

• arterial hypertension
• stroke
• blood pressure
• arterial pressure