Management of hypertension immediately after stroke

Jun 23 2008

A research project at the University of Leicester in conjunction with the University of East Anglia, indicates that early reduction of high blood pressure following stroke is feasible and safe, and both Labetalol & Lisinopril were found to be suitable a medications for this purpose.

Larger studies will now be necessary to confirm this result and test the effects on recovery from stroke.

Amit Mistri, a postgraduate researcher working on this project commented: "Stroke is a debilitating condition with high death and dependency rates. There are many unanswered dilemmas in the early management of people who have suffered a stroke.

"For early treatment of strokes caused by a clot in the circulation, aspirin is the only medication shown to be beneficial (small benefit), and clot-dissolving treatment (thrombolysis) is applicable to a minority only. No evidence-based treatment exists for early management of strokes secondary to bleeding within the brain. Elevated blood pressure represents a new therapeutic target in the early management of both types of stroke."

The research was funded and sponsored by the National Health Service Research and Development Health Technology Assessment Programme of the Department of Health.

Elevated peak arterial blood pressure (systolic blood pressure - SBP) following a stroke has been associated with worse outcome. It is not known whether early lowering of high SBP would be beneficial in improving outcome following stroke.

The research in Leicester was carried out as part of CHHIPS, a multicentre UK-based study, which compared the SBP lowering efficacy of two medications (labetalol and lisinopril) with dummy medication (placebo).

179 patients with high SBP (>160 mmHg) were randomly allocated to receive labetalol, lisinopril or a placebo. The dose was increased over the first 12 hours to attain a pre-specified SBP target, and continued for 2 weeks. Alternative formulations were available for those unable to swallow.

From a baseline SBP of 182 mmHg, average reduction of SBP at 24 hours in the individual groups was: labetalol-18, lisinopril-25, and placebo-11 mmHg. Active medication reduced SBP more than placebo at 24 hours. Both medications studied were not associated with an increase in further deterioration or adverse effects, compared to placebo.

Amit Mistri developed an interest in stroke research, during his training in Geriatric Medicine. The research was carried out in the Ageing & Stroke Medicine section of the Department of Cardiovascular Sciences, where he was a clinical research fellow, and the trial coordinator for the multi-centre CHHIPS study. His interests include: blood pressure in acute stroke, participation of stroke patients in research trials, epidemiology of stroke, and risk factor modification for secondary prevention of stroke.

The research is being presented to the public at the University of Leicester on Thursday 26th June. The Festival of Postgraduate Research introduces employers and the public to the next generation of innovators and cutting-edge researchers, and gives postgraduate researchers the opportunity to explain the real world implications of their research to a wide ranging audience.

More information about the Festival of Postgraduate Research is available at: www.le.ac.uk/gradschool/festival