Effect of Blood Pressure Lowering Therapy in Stroke Patients

Objective: The objective of the study is to assess the effect of blood pressure lowering with Candesartan in patients with stroke and elevated blood pressure admitted in this hospital.Study Design: Prospective descriptive observational study.Setting: Neurosurgery, Medical Emergency / OPD, Lady Reading Hospital, Peshawar.Materials and Methods: This descriptive study was done at the Department of Medicine and Neurosurgery, Postgraduate Medical Institute, Lady Reading Hospital Peshawar from January 2013 to May 2014 (for One year and 5 months period) in a total of 357 patients. In this descriptive study, patients presenting to Emergency department or OPD with stroke and elevated blood pressure, presenting within 30 hours of symptom onset and with SBP ? 140 mmHg, diastolic > 90 mmHg, were eligible for inclusion. Exclusion criteria were contraindicat-ions to or ongoing treatment with an angiotensin receptor blocker, markedly reduced consciousness, patients with chronic heart failure and intolerance to ACE inhibitors, patient unavailability for follow-up and pregnancy or breast – feeding. The acute phase treatment was a fixed dose of 4 mg on day 1, 8 mg on day 2 and 16 mg on days 3 to 7. Blood pressure was measured daily with the patient in the supine position using a blood pressure monitor. All patients were follow-up on day 7 and at 1 and 6 months after discharged from hospital.Results: Among 357 cases, 68.06% were males and 31.93% females. Majority (37.25%) belongs to age group of 61 – 70 years. Out of these, 66.10% patients were found to have ischemic and 33.89% patients had hemorrhagic stroke. Highest (40.05%) patients belonged to severe hypertensive group i.e. ? 180/110 mmHg. Target was achieved in 75.91% patients.Conclusions: Our data suggests that lowering BP in acute ICH is probably safe; however, it remains to be seen if this decreases hematoma expansion or improves outcome