Management of HTN in Stroke

Question 1

Management of HTN in Stroke

Ischemic stroke:

Answer 1

SBP control < 130 mm Hg has been shown to reduce recurrent strokes (2.25% vs. 2.77% per patient-year) and ICH at the expense of increased risk of orthostasis with syncope: Secondary Prevention of Small Subcortical Strokes (SPS3) trial.

Question 2

Management of HTN in Stroke

Hemorrhagic stroke, ICH:

Answer 2

Intensive BP Reduction in Acute Cerebral Hemorrhage Trial (INTERACT 2):

2,974 participants (2/3 were Chinese) with SBP 150 to 220 mm Hg at diagnosis of ICH were randomized to BP control to <140 mm Hg or <180 mm Hg within 1 hour of randomization, with maintenance for the ensuing 7 days or until time of discharge: Trend toward better outcomes noted in early intensive treatment group (attainment of SBP < 140 mm Hg within the first hour).

Question 3

Management of HTN in Stroke

Hemorrhagic stroke, ICH:

Answer 3

Ongoing study: North American Antihypertensive Treatment of Acute Cerebral Hemorrhage II (ATACH II) trial: study outcome in patients with acute ICH treated to a SBP < 140 mm Hg versus <180 mm Hg.