Blood pressure guidelines for stroke may not be relevant to many patients

Guidelines on blood pressure lowering after stroke may not be applicable to many patients under the care of their family doctor, warn researchers in this week's British Medical Journal.

International guidelines stress the importance of lowering blood pressure in people who have had a stroke. These guidelines are largely based on the results of the PROGRESS trial, which recruited people with stroke from hospital.

But are these guidelines relevant to patients in primary care, ask researchers at the University of Birmingham?

They compared the characteristics of stroke patients from seven general practices in Birmingham with those of the participants in the PROGRESS trial.

Patients were 12 years older than the PROGRESS participants and twice as likely to be women. The average time that had elapsed since their cerebrovascular event was two to three years, compared with eight months in PROGRESS.

For 61% of patients systolic blood pressure was above the target recommended in the UK guidelines, and for 77% it was over the target set out by the British Hypertension Society.

The "typical" stroke patient in general practice is very different from the PROGRESS study population, say the authors. In this case, the differences are so great that they undermine the applicability of the research to primary care.

Research in appropriate populations is urgently needed before international guidelines are implemented in primary care, they conclude.