Controlling Hypertension and Hypotension Immediately Post Stroke | Journal Scan

May 08, 2015
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Authors:
Manning LS, Mistri AK, Potter J, Rothwell PM, Robinson TG.
Citation:
Short-Term Blood Pressure Variability in Acute Stroke: Post Hoc Analysis of the Controlling Hypertension and Hypotension Immediately Post Stroke and Continue or Stop Post-Stroke Antihypertensives Collaborative Study Trials. Stroke 2015;Apr 23:[Epub ahead of print].
Summary By:
Debabrata Mukherjee, MD, FACC

Study Questions:

What is the effect of short-term blood pressure variability (BPV) on outcome after acute stroke?

Methods:

CHHIPS (Controlling Hypertension and Hypotension Immediately Post Stroke) was a trial of BP-lowering after stroke, enrolling 179 acute stroke patients (onset <36 hours). COSSACS (Continue or Stop Post-Stroke Antihypertensives Collaborative Study) compared a strategy of continuation versus temporarily stopping prestroke antihypertensive therapy in 763 acute stroke patients (onset <48 hours). BPV at baseline (defined as SD, coefficient of variation, variation independent of the mean, and average real variability) was derived from standardized casual cuff BP measures (6 readings <30 minutes). Adjusted logistic regression models were used to assess the relation between BPV and death and disability (modified Rankin scale >3) at 2 weeks.

Results:

Included in the analysis were 706 (92.5%) and 171 (95.5%) participants for the COSSACS and CHHIPS data sets, respectively. Adjusted logistic regression analyses revealed no statistically significant associations between any of the included BPV parameters with 2-week death or disability in either study data set: COSSACS, odds ratio SD systolic BP 0.98 (0.78–1.23); CHHIPS, odds ratio SD systolic BP 0.97 (0.90–1.11).

Conclusions:

The authors concluded that short-term BPV is not a useful predictor of early (2 weeks) outcome after acute stroke.

Perspective:

This study shows no significant association between baseline BPV and the composite outcome of 2-week death or dependency. Although short-term BPV may simply have no effect on outcome, another possible explanation is that casual cuff measures lack the necessary precision to accurately detect short-term BP fluctuations. Furthermore, no BPV increase was seen with use of labetalol in the first 2 weeks after acute stroke, supporting its continued use as a first-line antihypertensive agent in the treatment of elevated BP after acute stroke. Additional prospective studies with more precise detection of BP fluctuations after acute stroke and outcomes are indicated.

Keywords: Antihypertensive Agents, Blood Pressure, Blood Pressure Determination, Hypertension, Hypotension, Labetalol, Logistic Models, Prospective Studies, Stroke


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