SHOULD HYPERTENSION BE TREATED AFTER ACUTE STROKE - A RANDOMIZED CONTROLLED TRIAL USING SINGLE-PHOTON EMISSION COMPUTED-TOMOGRAPHY

Objective.-To determine if previously hypertensive patients with acute ischemic Stroke should be treated with antihypertensive medication in the immediate poststroke period. Design.-Randomized double-blind, pla cebo-controlled trial. Setting.-Acute-care teaching hospital. Patients .-Sixteen consecutive hypertensive patients (four men and 12 women; me an age, 66 years [age range, 46 to 83 years]) with middle cerebral art ery infarction within 72 hours of onset and blood pressure between 170 and 220 mm Hg (systolic) and 95 and 120 mm Hg (diastolic). Interventi on.-Placebo (n=6), nicardipine hydrochloride (20 mg [n=51), captopril (12.5 mg [n=3]), or clonidine hydrochloride (0.1 mg [n=2]) given every 8 hours for 3 days. Main Outcome Measures.-Decline in blood pressure, change in cerebral blood flow as measured by single photon emission c omputed tomography, and clinical change as determined by the National Institutes of Health Stroke Scale. Results.-Blood pressure fell signif icantly in both the drug-treated group as a whole and in those patient s receiving placebo (P<.001). There was no difference in blood pressur e levels between these two groups throughout the study period. Patient s receiving nicardipine had a consistently lower pressure than the oth er groups- A significant negative relationship was noted between the m aximum blood pressure fall and improvement in cerebral blood flow. The re were four patients whose blood pressure dropped by more than 16% of the baseline value on any 24 hours in the first 3 days. All either fa iled to increase or actually decreased their cerebral blood flow to th e affected area. Three of these patients were treated with nicardipine . There was no significant difference in clinical course between the p lacebo- and drug-treated groups as a whole. Conclusions.-Hypertensive ischemic stroke patients with a moderate elevation of blood pressure i n the first few days may not require antihypertensive therapy. Nicardi pine and possibly other calcium channel blockers may cause an excessiv e fall in blood pressure and impair cerebral blood flow in these patie nts and should therefore be used with caution.