Stroke Risk After Emergency Department Treatment of Elevated Blood Pressure in Transient Ischemic Attack
Annals of Emergency Medicine
Objectives: Hypertension (HTN) is a well-known risk factor for developing stroke after transient ischemic attack (TIA); however, it is unknown whether acute treatment of elevated blood pressure (BP) in TIA patients in the emergency department (ED) alters stroke risk. We aimed to evaluate the effect of lowering BP on stroke risk in this population. Additionally, we aimed to investigate alteration in intensive care unit (ICU) admit rates, hospital length of stay (LOS), and discharge disposition. Methods: A retrospective cohort study was conducted evaluating TIA patients in the ED with elevated BP. This study was conducted at the 8 hospital Beaumont System in Metro Detroit and included adult patients diagnosed with TIA in the ED with a diastolic BP 140 mm Hg and/or systolic 90 mm Hg. Demographic data collected included age, sex, race, degree of HTN, and past medical history of HTN. Further data included whether or not anti-HTN therapy was administered in the ED, stroke occurrence in the subsequent hospital stay, hospital LOS, ICU admission rates, and discharge disposition. Patient characteristics were summarized using descriptive statistics and tests of bi-variant analysis were performed using a t-test. We assessed the effects of antiHTN treatment using multivariable logistic regression controlling for patient characteristics. Results: A total of 3,095 patients were included in the final analysis, with a median age of 73 years old; 55.8% were female. Of these, 649 (21.0%) received anti-HTN treatment while in the ED. 429 (13.9%) patients suffered a stroke after admission. We observed no significant decrease in stroke in the treatment group compared to the notreatment group after adjusting for age, sex, race (15.1% vs 13.5%) (aOR, 0.95 [95% CI, 0.72-1.26]). We observed a minimal increase in hospital LOS in the treatment group compared to non-treatment group (2.12 days vs 1.92 days), (aOR, 0.44 [95% CI, 0.27-0.61]), (p <.0001), but no significant differences were seen in ICU admissions (2.77% vs 2.17%), (aOR, 1.24 [95% CI, 0.72 - 2.14]) or discharge disposition. Conclusions: In this observational study of TIA patients with elevated BP in the ED, there was no difference seen in subsequent stroke between patients who were treated with anti-HTN therapy compared to those who were not. Future studies should evaluate these results using a randomized controlled study design.
Biel A, Todd B. Stroke risk after emergency department treatment of elevated blood pressure in transient ischemic attack. Ann Emerg Med. 2023 Oct;82(4 Suppl.):S151-S152. doi:10.1016/j.annemergmed.2023.08.371