A feasibility and safety study of immediate blood pressure manipulation in acute post-stroke patients
thesisposted on 15.12.2014, 10:34 by Amit K. Mistri
This thesis examines the feasibility and safety of blood pressure (BP) lowering using labetalol or lisinopril, in acute ischaemic or haemorrhagic stroke within the confines of a randomised double-blind placebo-controlled trial.;A systematic review of pressor therapy in acute stroke identified pilot studies which have reported no harmful effects, and no randomised controlled trials. While pressor therapy was not investigated in this study, centres with established rapid admission protocols, availability of urgent computerized tomography and intensive monitoring facilities will be needed for such a study.;Elevated BP following acute stroke is associated with adverse prognosis. Whether BP lowering in this situation is beneficial or harmful is unknown. Active intervention in this study significantly reduced SBP during the first 24 hours and at two weeks, but not DBP, compared to placebo. No significant difference in short-term outcome (death and dependency at 2 weeks), or adverse events (including early neurological deterioration) was seen.;Sublingual lisinopril for dysphagic patients was as effective and well-tolerated as oral lisinopril. This is a novel method of administering anti-hypertensives in acute stroke, which could be administered at first contact with healthcare providers, and does not require intensive monitoring as with intravenous agents like labetalol.;Recruitment to the study was poor, primarily due to inadequate number of centres, fewer patients conforming to eligibility criteria than initially estimated, and delays in hospital admission. Analysis of screening data showed that only a small minority of patients with acute stroke were randomised to one of two stroke-BP studies (<9%). This will limit the applicability of results to the clinical scenario.;A definitive trial of BP lowering in acute stroke with adequate sample size is needed.