The systemic haemodynamic and cerebral autoregulatory effects of bendrofluazide in the subacute post-stroke period.

Introduction: Little data exist on the efficacy in terms of blood pressure reduction or outcome measures for the various antihypertensive agents in patients post-stroke. In this study the effects of bendrofluazide on blood pressure levels and variability, dynamic cerebral autoregulation and cardiac baroreceptor sensitivity were assessed in the sub-acute stroke period.

Methods: A total of 36 hypertensive ischaemic stroke patients were randomized to oral bendrofluazide 2.5 mg daily or matching placebo starting 10 days post-ictus and continued for 28 days. A total of 12 hypertensive controls were similarly randomized in a double-blind, crossover study, each limb being of 28 days duration. Cerebral blood flow velocity, non-invasive beat-to-beat blood pressure levels, electrocardiograms (ECGs) and transcutaneous carbon dioxide levels were measured before and at the end of each treatment period in stroke and control subjects.

Results: Casual blood pressure levels were not significantly reduced in stroke patients with bendrofluazide, but in the placebo group levels increased by 13 +/- 13/6 +/- 7 mmHg (P < 0.001) at study termination. In the control group, casual systolic blood pressure fell during active treatment by 12 +/- 16 mmHg (P < 0.03) compared with placebo. Dynamic cerebral autoregulation, beat-to-beat blood pressure variability and cardiac baroreceptor sensitivity did not change with bendrofluazide or placebo in either the stroke patients or controls.

Conclusion: Bendrofluazide does not appear to be an effective hypotensive agent in the sub-acute post-stroke period but may limit the blood pressure rise seen during stroke recovery. Bendrofluazide however does not adversely influence dynamic cerebral autoregulation, blood pressure variability or cardiac baroreceptor sensitivity in either strokes or control subjects.