Blood pressure management in acute ischemic stroke.

Data from the Project for Improvement of Stroke Care Management in Minnesota were used to characterize provider practice in the management of hypertension in hospitalized acute ischemic stroke patients in relation to guidelines from the American Stroke Association (ASA) and the European Stroke Initiative (EUSI). Among 1181 patients, 129 received as-needed medication in direct response to elevated blood pressure in the first 24 hours after admission. Of these 129, 56% were overtreated according to ASA guidelines and 24% by EUSI guidelines. Of the 1052 patients not treated, 16% were undertreated by ASA guidelines and 3% by EUSI guidelines. In contrast, discharge hypertension was well treated, with 93% (424 of 454) of patients likely to have chronic hypertension appropriately treated with antihypertensive medication on discharge. These findings support the need for more research to fill identified gaps in evidence, improve treatment guidelines, and reduce variability in patient management.