The effect of antihypertensive monotherapy and combination on blood pressure in stroke patients

Ema Pristi Yunita; Saffana Qolby Mayana; Zamroni Afif

doi:10.15562/bmj.v11i1.2076

The effect of antihypertensive monotherapy and combination on blood pressure in stroke patients

Ema Pristi Yunita ,

Saffana Qolby Mayana ,

Zamroni Afif ,

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DOI: https://doi.org/10.15562/bmj.v11i1.2076 |
Published: 2022-04-30

Abstract

Background: Stroke is a syndrome characterized by loss of focal and function of the rapidly developing CNS. Furthermore, hypertension is a known risk factor that occurs approximately 70% of the time, and lowering systolic BP from 1 to 3 mmHg effectively reduces the risk of stroke by 20 to 30%.

Methods: An observational analytic design, using a retrospective medical record data collection in Malang City Hospital. A total of 113 patients met the inclusion criteria. In addition, the inclusion criteria include hospitalized patients with a primary diagnosis of stroke, ischemia or bleeding as evidenced by a head CT scan, having comorbid hypertension, and having received antihypertensive therapy. Meanwhile, the exclusion criteria were the BP data of the patient measured only once.

Results: The results showed the ability of antihypertensive monotherapy and combinations to lower systolic BP by 33.62 ± 30.15 mmHg and 30.50 ± 29.47 mmHg (p = 0.744) in ischemic patients. In comparison, diastolic BP decreased by 6.86 ± 13.18 mmHg and 11.50 ± 16.26 mmHg (0.291), respectively. Moreover, the administration in bleeding stroke patients resulted in a decrease to 16.95 ± 17.89 mmHg and 22.82 ± 23.91 mmHg, (p = 0.029) for systolic, and 8.63 ± 14.63 mmHg and 8.71 ± 17.17 mmHg (p = 0.647) for diastolic BP, respectively. Furthermore, a combination of 4 antihypertensives drugs showed a better decrease in systolic BP in both patients (44.50 ± 21.63) compared to monotherapy, and a mixture of 2 as well as three drugs, by 27.02±27.05, 25.65 ± 29.97, and 25.37 ± 25.08 (p = 0.027), respectively.

Conclusions: Combination therapy is recommended in stroke patients because BP can be better controlled.

References

Carolei A. Transient ischemic attack and stroke: diagnosis, investigation and management. J Headache Pain. 2009;10:225. doi: 10.1007/s10194-009-0121-7.
Geddes L, Hanson M, Roberts A, Ellis H, Standring S. Human anatomy the definitive visual guide. London: Dorling Kindersley Publishing; 2014. p. 1-256.
Kelly EB. An overview of stroke. 1st ed. In: Gillard A, editor. New York: Greenhaven Press; 2013. p. 16-9.
Holm SW, Cunningham LL, Bensadoun E, Madsen MJ. Hypertension: classification, pathophysiology, and management during outpatient sedation and local anesthesia. J Oral Maxillofac Surg. 2006;64:111-21. doi: 10.1016/j.joms.2005.09.023.
Staessen JA, Kuznetsova T, Stolarz K. Hypertension prevalence and stroke mortality across populations. JAMA. 2003;289(18):2420–22.
PERDOSSI, Guideline stroke tahun 2011. Jakarta: Perhimpunan Dokter Spesialis Saraf Indonesia (PERDOSSI); 2011. p. 1-131.
Appleton JP, Sprigg N, Bath PM. Blood pressure management in acute stroke. Stroke Vasc. Neurol. 2016;1:72–82. doi: 10.1136/svn-2016-000020.
Choudhury MJ, Chowdhury MT, Nayeem A, Jahan WA. Modifiable and non-modifiable risk factors of stroke: a review update. J Natl Inst Neurosci Bangladesh. 2015;1(1):22–6.
Yu J, Zhou R, Cai G. From hypertension to stroke: mechanisms and potential prevention strategies. CNS Neurosci Ther. 2011;17:577–84. doi: 10.1111/j.1755-5949.2011.00264.x.
Wengrofsky P, Lee J, Makaryus AN. Dyslipidemia and its role in the pathogenesis of atherosclerotic cardiovascular disease : implications for evaluation and targets for treatment of dyslipidemia Based on Recent Guidelines. IntechOpen; 2019. p. 1–31.
Jane N, Nyakoojo A, Alice N, Nicholas B, Ddumba E. A descriptive epidemiological study on stroke in Kampala, Uganda: a hospital-based study. Afr J Neurol Sci. 2012;31(1):41–8.
Angeli F, Verdecchia P, Reboldi GP, Gattobigio R, Bentivoglio M, Staessen JA, et al. Calcium channel blockade to prevent stroke in hypertension. Am J Hypertens. 2004;17:817–22. doi: 10.1016/j.amjhyper.2004.06.002.
Gradman AH, Basile JN, Carter BL, Bakris GL. Combination therapy in hypertension. J Am Soc Hypertens. 2010;4(1):42–50. doi: 10.1016/j.jash.2010.02.005.
Fares H, Dinicolantonio JJ, O'Keefe JH, Lavie CJ. Amlodipine in hypertension: a first-line agent with efficacy for improving blood pressure and patient outcomes. Open Hear. 2016:1–7. doi: 10.1136/openhrt-2016-000473.
Bakris GL. Combined therapy with a calcium channel blocker and an angiotensin II type 1 receptor blocker. J Clin Hypertens. 2008;10(1):27–32.
Noubiap JJ. Effect of initial antihypertensive combination therapy on primary stroke prevention. J Thorac Dis. 2015;7(5):787–9. doi: 10.3978/j.issn.2072-1439.2015.05.06.
Deswal A, Mann DL. Angiotensin receptor blockers in the treatment of heart failure. In: A. M. Feldman, editor. Heart failure: pharmacologic management. Hoboken: Blackwell Publishing; 2006. p. 44–56.

[1] Carolei A. Transient ischemic attack and stroke: diagnosis, investigation and management. J Headache Pain. 2009;10:225. doi: 10.1007/s10194-009-0121-7.

[2] Geddes L, Hanson M, Roberts A, Ellis H, Standring S. Human anatomy the definitive visual guide. London: Dorling Kindersley Publishing; 2014. p. 1-256.

[3] Kelly EB. An overview of stroke. 1st ed. In: Gillard A, editor. New York: Greenhaven Press; 2013. p. 16-9.

[4] Holm SW, Cunningham LL, Bensadoun E, Madsen MJ. Hypertension: classification, pathophysiology, and management during outpatient sedation and local anesthesia. J Oral Maxillofac Surg. 2006;64:111-21. doi: 10.1016/j.joms.2005.09.023.

[5] Staessen JA, Kuznetsova T, Stolarz K. Hypertension prevalence and stroke mortality across populations. JAMA. 2003;289(18):2420–22.

[6] PERDOSSI, Guideline stroke tahun 2011. Jakarta: Perhimpunan Dokter Spesialis Saraf Indonesia (PERDOSSI); 2011. p. 1-131.

[7] Appleton JP, Sprigg N, Bath PM. Blood pressure management in acute stroke. Stroke Vasc. Neurol. 2016;1:72–82. doi: 10.1136/svn-2016-000020.

[8] Choudhury MJ, Chowdhury MT, Nayeem A, Jahan WA. Modifiable and non-modifiable risk factors of stroke: a review update. J Natl Inst Neurosci Bangladesh. 2015;1(1):22–6.

[9] Yu J, Zhou R, Cai G. From hypertension to stroke: mechanisms and potential prevention strategies. CNS Neurosci Ther. 2011;17:577–84. doi: 10.1111/j.1755-5949.2011.00264.x.

[10] Wengrofsky P, Lee J, Makaryus AN. Dyslipidemia and its role in the pathogenesis of atherosclerotic cardiovascular disease : implications for evaluation and targets for treatment of dyslipidemia Based on Recent Guidelines. IntechOpen; 2019. p. 1–31.

[11] Jane N, Nyakoojo A, Alice N, Nicholas B, Ddumba E. A descriptive epidemiological study on stroke in Kampala, Uganda: a hospital-based study. Afr J Neurol Sci. 2012;31(1):41–8.

[12] Angeli F, Verdecchia P, Reboldi GP, Gattobigio R, Bentivoglio M, Staessen JA, et al. Calcium channel blockade to prevent stroke in hypertension. Am J Hypertens. 2004;17:817–22. doi: 10.1016/j.amjhyper.2004.06.002.

[13] Gradman AH, Basile JN, Carter BL, Bakris GL. Combination therapy in hypertension. J Am Soc Hypertens. 2010;4(1):42–50. doi: 10.1016/j.jash.2010.02.005.

[14] Fares H, Dinicolantonio JJ, O'Keefe JH, Lavie CJ. Amlodipine in hypertension: a first-line agent with efficacy for improving blood pressure and patient outcomes. Open Hear. 2016:1–7. doi: 10.1136/openhrt-2016-000473.

[15] Bakris GL. Combined therapy with a calcium channel blocker and an angiotensin II type 1 receptor blocker. J Clin Hypertens. 2008;10(1):27–32.

[16] Noubiap JJ. Effect of initial antihypertensive combination therapy on primary stroke prevention. J Thorac Dis. 2015;7(5):787–9. doi: 10.3978/j.issn.2072-1439.2015.05.06.

[17] Deswal A, Mann DL. Angiotensin receptor blockers in the treatment of heart failure. In: A. M. Feldman, editor. Heart failure: pharmacologic management. Hoboken: Blackwell Publishing; 2006. p. 44–56.

The effect of antihypertensive monotherapy and combination on blood pressure in stroke patients

Abstract

References

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