We explored knowledge and perceptions of physicians regarding management of
hypertension in acute ischemic stroke patients and use of various anti-hypertensive
medicines as primary and secondary prevention of stroke.
Subjects and Methods
A survey was designed with 7 statements derived from the recommendations from
American Heart Association (AHA)/American Stroke Association stroke council
guidelines 2006 and the 7th report of the Joint National Committee (JNC VII 2003).
Eighty surveys were distributed to the physicians at Shifa College and Shifa International
Hospital, and Pakistan Institute of Medical Sciences, Islamabad.
Fifty surveys were returned and the act of responding was taken as consent for
participation. Mean duration from graduation (MBBS) was 10.3±9.9 years. When asked
about the management of a BP of 170/90 mm Hg in a patient with acute stroke during
first 3 and 24 hours, 58.6% and 60% recommended that patient be treated for this blood
pressure on these intervals. When asked about the most effective primary prevention for
ischemic stroke in a hypertensive patient, 69.7% thought that lowering blood pressure is
the single most important factor and 21.2% thought aspirin as the sole first line primary
prevention. 22.5% recommended angiotensin converting enzyme inhibitors and or
angiotensin receptor blockers as the primary anti-hypertensive therapy for secondary
prevention of a hypertensive ischemic stroke. 50% thought that females do not have
higher importance as compared with guidelines
There is a considerable gap between evidence based recommendations and actual
perceptions of physicians in managing hypertension in stroke patients. This would require
an urgent attention to emphasize evidence based practice. (Rawal Med J 2010;35: ).
Hypertension, ischemic stroke, Evidence based practice.