Category: Professional Posters
Purpose: Hypertension (HTN) is a common early finding in patients presenting with acute ischemic stroke. Treating HTN in the acute setting is controversial, since both high and low blood pressures are associated with poor outcomes. Current American Stroke Association (ASA) guidelines recommend treating systolic blood pressure (SBP) ≥ 220 mmHg and/or diastolic blood pressure (DBP) ≥ 120 mmHg in patients ineligible for thrombolytics; however, make no recommendations regarding a blood pressure target. Thus, prescribing patterns of antihypertensive medications will vary. The aim of this study is to describe and evaluate the utilization of antihypertensive drugs in the emergency department (ED).
Methods: A retrospective, multicenter, observational study was conducted between February and May 2019. Patients diagnosed with acute ischemic stroke were included, while patients with transient ischemic attacks and hemorrhagic strokes were excluded. A standard questionnaire was used and collected the following data: demographic characteristics, past medical history, SBP and DBP at admission, pharmacotherapy administered in the ED (thrombolytics and antihypertensive medications) and modified Rankin scale (mRs) at admission >2 defined as “bad prognosis”. The primary outcome of this study was to describe the utilization of antihypertensive drugs in the ED. The secondary outcome was to assess whether patients were over-treated with antihypertensive drugs; in patients who did not receive thrombolytics, overtreatment was defined as SBP < 220 and/or DBP < 120 and prescribed an antihypertensive, while in those who received thrombolytics, overtreatment was defined as SBP of < 185 and/or DBP of < 105 and prescribed an antihypertensive. The Institutional Review Board of the hospitals approved the study design. Statistical analysis was done using the Statistical Package for the Social Sciences version 22.0 (SPSS).
Results: A total of 146 patients were included with a mean age (± standard deviation) of 76.55 years (± 11.86) and 56.8% were females. More than half of the patients were on antihypertensive medications 53.7% and 76.7% had a previous history of hypertension. The mean SBP and DBP at baseline were 160.61 ± 31.27mmHg and 85.45 ± 14.87mmHg, respectively. Only 5.5% of the patients had SBP of more than or equal to 220 and 2.1% were given thrombolytics. Regarding blood pressure management in the ED: overtreatment was observed in 60% of the patients and, amlodipine was the most prescribed antihypertensive (31.9%), followed by nitroglycerin patch (23.6%), angiotensin converting enzyme inhibitors (18.1%), labetalol (13.9%), and nicardipine (1.6%). Over-treatment was more evident in patients with a previous history of hypertension, were at least on one antihypertensive drug before admission to the hospital, had mRs > 2 upon admission to the hospital, and those 65 years and older (p-value of < 0.05). However, gender and level of consciousness at admission were not associated with overtreatment (p>0.05).
Conclusion: This study highlights the non-adherence to the guidelines of blood pressure management in acute ischemic stroke. The underlying reasons for overtreatment in this study are mainly due to either previous hypertension diagnosis or higher mRs upon hospital admission. The findings also support the fact that thrombolytics are inadequately prescribed in acute ischemic stroke which raises the need for optimizing patients’ education about the early presentation to the hospital after onset of the symptoms.