Emergency Department Adherence to American Heart Association Guidelines for Blood Pressure Management in Acute Ischemic Stroke

Background and Purpose—Severely elevated blood pressure (BP) and aggressive BP reduction are both associated with poor outcome in acute ischemic stroke (AIS). In nontissue-type plasminogen activator patients, the American Heart Association recommends antihypertensive therapy only if BP is220/120 mm Hg with a goal of 15 % to 25 % reduction in the first 24 hours. We hypothesized that patients with AIS often receive antihypertensives in the emergency department below the recommended threshold and that BP reduction is often 20%. Methods—In 2005, AIS cases were ascertained at all 16 hospitals in Greater Cincinnati. BP was recorded at emergency department presentation and before and after antihypertensive treatment. Hypertension was defined as BP 220/ 120 mm Hg. Chi-square and Mann-Whitney U tests were used for comparisons. Results—A total of 1739 patients with AIS met inclusion criteria. Median age was 72 years with 43 % male and 25 % black. Of 218 treated with antihypertensives, 65 (30.0%) met treatment criteria immediately before treatment. Treated patients were younger (66 versus 73 years, P0.001) with greater stroke severity than untreated patients (National Institutes of Health Stroke Scale score 4 versus 3, P0.028). Median change in systolic BP was 25 mm Hg (range, 96 to 25 mm Hg). Median percentage change in systolic BP was 12.3 % (range, 49.2 % to 16.1%). Systolic BP decreased 20 % in 52 treated patients (23.7%). Conclusions—Only one third of patients with AIS treated with antihypertensives met American Heart Association