Abstract
Acute elevation in blood pressure (acute hypertensive response) is commonly observed in the early period of both ischemic and hemorrhagic stroke. The management of acute hypertensive response depends upon the underlying intracranial pathology. Management of acute hypertensive response has been the focus of many trials and studies such as the SCAST trial, CHHIPS trial, COSSACS trial, INTERACT, and ATACH trial, which are discussed here. However, there were many limitations to these trials including time of presentation, different pathophysiology of ischemic strokes versus hemorrhagic strokes, and patient related factors. Ongoing clinical trials which take these limitations into account include ENCHANTED trial, ATACH II trial, INTERACT 2 trial, and ENOS trial. The results of these trials are expected to modify current guidelines of acute stroke, both ischemic and hemorrhagic, and potentially improve clinical outcomes and quality of life.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Qureshi AI, Ezzeddine MA, Nasar A, Suri MF, Kirmani JF, Hussein HM, et al. Prevalence of elevated blood pressure in 563,704 adult patients with stroke presenting to the ED in the United States. Am J Emerg Med. 2007;25(1):32–8.
Arboix A, Roig H, Rossich R, Martinez EM, Garcia-Eroles L. Differences between hypertensive and non-hypertensive ischemic stroke. Eur J Neurol. 2004;11(10):687–92.
Patarroyo SX, Anderson C. Blood pressure lowering in acute phase of stroke: latest evidence and clinical implications. Ther Adv Chronic Dis. 2012;3(4):163–71. doi:10.1177/2040622312450183.
Qureshi AI. Acute hypertensive response in patients with stroke: pathophysiology and management. Circulation. 2008;118(2):176–87.
Orlandi G, Fanucchi S, Strata G, Pataleo L, Landucci Pellegrini L, Prontera C, et al. Transient autonomic nervous system dysfunction during hyperacute stroke. Acta Neurol Scand. 2000;102(5):317–21.
Lattanzi S, Silvestrini M, Provinciali L. Elevated blood pressure in the acute phase of stroke and the role of Angiotensin receptor blockers. Int J Hypertens. 2013;2013:941783. doi:10.1155/2013/941783.
Sandset EC, Bath PM, Boysen G, Jatuzis D, Korv J, Luders S, et al. The angiotensin-receptor blocker candesartan for treatment of acute stroke (SCAST): a randomised, placebo-controlled, double-blind trial. Lancet. 2011;377(9767):741–50. doi:10.1016/S0140-6736(11)60104-9.
Potter JF, Robinson TG, Ford GA, Mistri A, James M, Chernova J, et al. Controlling hypertension and hypotension immediately post-stroke (CHHIPS): a randomised, placebo-controlled, double-blind pilot trial. Lancet Neurol. 2009;8(1):48–56. doi:10.1016/S1474-4422(08)70263-1.
Robinson TG, Potter JF, Ford GA, Bulpitt CJ, Chernova J, Jagger C, et al. Effects of antihypertensive treatment after acute stroke in the Continue or Stop Post-Stroke Antihypertensives Collaborative Study (COSSACS): a prospective, randomised, open, blinded-endpoint trial. Lancet Neurol. 2010;9(8):767–75. doi:10.1016/S1474-4422(10)70163-0.
Anderson CS, Huang Y, Wang JG, Arima H, Neal B, Peng B, et al. Intensive blood pressure reduction in acute cerebral haemorrhage trial (INTERACT): a randomised pilot trial. Lancet Neurol. 2008;7(5):391–9.
Anderson CS, Huang Y, Arima H, Heeley E, Skulina C, Parsons MW, et al. Effects of early intensive blood pressure-lowering treatment on the growth of hematoma and perihematomal edema in acute intracerebral hemorrhage: the Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT). Stroke. 2010;41(2):307–12. doi:10.1161/STROKEAHA.109.561795.
•• Qureshi A, Palesch Y. Expansion of recruitment time window in antihypertensive treatment of acute cerebral hemorrhage (ATACH) II trial. J Vasc Interv Neurol. 2012;5(supp):6–9. This is an ongoing trial which evaluates the efficacy of early, intensive, antihypertensive treatment using intravenous nicardipine initiated within 3 h of onset of intracerebral hemorrhage.
• Delcourt C, Huang Y, Wang J, Heeley E, Lindley R, Stapf C, et al. The second (main) phase of an open, randomised, multicentre study to investigate the effectiveness of an intensive blood pressure reduction in acute cerebral haemorrhage trial (INTERACT2). Int J Stroke. 2010;5(2):110–6. doi:10.1111/j.1747-4949.2010.00415. This is the main phase trial which evaluates early intensive blood pressure lowering and effects on hematoma expansion within 6 h of onset of intracerebral hemorrhage.
Glyceryl trinitrate vs. control, and continuing vs. stopping temporarily prior antihypertensive therapy, in acute stroke: rationale and design of the Efficacy of Nitric Oxide in Stroke (ENOS) trial (ISRCTN99414122). Int J Stroke. 2006;1(4):245–9. doi:10.1111/j.1747-4949.2006.00059.x.
Qureshi AI, Palesch YY, Martin R, Novitzke J, Cruz-Flores S, Ehtisham A, et al. Effect of systolic blood pressure reduction on hematoma expansion, perihematomal edema, and 3-month outcome among patients with intracerebral hemorrhage: results from the antihypertensive treatment of acute cerebral hemorrhage study. Arch Neurol. 2010;67(5):570–6. doi:10.1001/archneurol.2010.61.
Antihypertensive treatment of acute cerebral hemorrhage. Crit Care Med. 2010;38(2):637–48. doi:10.1097/CCM.0b013e3181b9e1a5.
Anderson C. Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED). 2011. http://clinicaltrials.gov/show/NCT01422616. Accessed 06/20/2013.
Jauch EC, Saver JL, Adams Jr HP, Bruno A, Connors JJ, Demaerschalk BM, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(3):870–947. doi:10.1161/STR.0b013e318284056a.
Broderick JP, Adams Jr HP, Barsan W, Feinberg W, Feldmann E, Grotta J, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke. 1999;30(4):905–15.
Qureshi AI, Tuhrim S, Broderick JP, Batjer HH, Hondo H, Hanley DF. Spontaneous intracerebral hemorrhage. N Engl J Med. 2001;344(19):1450–60. doi:10.1056/NEJM200105103441907.
Jung SY, Choi NK, Kim JY, Chang Y, Song HJ, Lee J, et al. Short-acting nifedipine and risk of stroke in elderly hypertensive patients. Neurology. 2011;77(13):1229–34. doi:10.1212/WNL.0b013e318230201a.
Compliance with Ethics Guidelines
Conflict of Interest
Syeda L. Alqadri, Varun Sreenivasan, and Adnan I. Qureshi declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Author information
Authors and Affiliations
Corresponding author
Additional information
This article is part of the Topical Collection on Stroke
Rights and permissions
About this article
Cite this article
Alqadri, S.L., Sreenivasan, V. & Qureshi, A.I. Acute Hypertensive Response Management in Patients with Acute Stroke. Curr Cardiol Rep 15, 426 (2013). https://doi.org/10.1007/s11886-013-0426-7
Published:
DOI: https://doi.org/10.1007/s11886-013-0426-7