title: Intensive blood pressure-lowering treatment in patients with acute lacunar infarction.
abstract: BACKGROUND
  The optimal management of high blood pressure (BP) during the acute stage of stroke has yet to be established. To test the extent to which BP can be lowered without causing adverse effects and to determine the safety or efficacy of administration of antihypertensive agents in acute ischemic stroke, we performed ambulatory BP monitoring (ABPM) before and after administration of angiotensin receptor blockers (ARBs) with and without diuretics to monitor the ABPM profile after acute lacunar infarction. Patients with lacunar infarcts are presumed to be less vulnerable to reduced cerebral perfusion pressure in the ischemic tissue because of BP lowering.
  
  
  METHODS
  We prospectively performed ABPM during the acute stage and around 3 weeks after ictus for 59 patients with lacunar infarction. As a historical control group, we selected 60 consecutive patients with acute lacunar infarction who were admitted during the period of 1 year before the present study and treated according to the guidelines.
  
  
  RESULTS
  Baseline data, prevalence of progressive motor deficits, and modified Rankin Scale scores 3 months after ictus were not significantly different between both groups. ARB with or without diuretics lowered 24-hour systolic BP and diastolic BP by 27.8 and 12.7 mm Hg, daytime systolic BP and diastolic BP by 26.8 and 12.0 mm Hg, and nighttime systolic BP and diastolic BP by 30.2 and 12.0 mm Hg. The incidence of dippers tended to increase in the second measurement from 11 (18.6%) to 20 (33.8%; P=.093).
  
  
  CONCLUSIONS
  Considerable reduction in 24-hour BP levels was attained around day 21. The limit of BP level to which BP can be safely lowered appears to be lower than that was previously considered.
authors.affiliation: Department of Neurology, Kyoto Second Red Cross Hospital, Kyoto, Japan. Electronic address: yyamamot@fg7.so-net.ne.jp.
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Nagakane
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Ohara
authors.forename: Eijiro
authors.initials: E
authors.lastname: Tanaka
authors.forename: Fukiko
authors.initials: F
authors.lastname: Morii
authors.forename: Takashi
authors.initials: T
authors.lastname: Koizumi
authors.forename: Manabu
authors.initials: M
authors.lastname: Muranishi
authors.forename: Hidesato
authors.initials: H
authors.lastname: Takezawa
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D018660:Blood Pressure Monitoring, Ambulatory; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies; D059409:Stroke, Lacunar / Q000188:drug therapy*
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000959:Antihypertensive Agents; D004232:Diuretics
keywords: Acute stroke; ambulatory blood pressure monitoring; angiotensin receptor blocker; diuretics; intensive blood pressure lowering; lacunar infarction; nondipper