A calcium channel or angiotensin converting enzyme inhibitor/angiotensin receptor blocker regime to reduced blood pressure variability in acute ischaemic stroke (CAARBS): A feasibility trial

Davison, William; Appiah, Karen; Robinson, Thompson G.; McGurgan, Iain; Rothwell, Peter M.; Potter, John F.

doi:10.1016/j.jns.2020.116753

Cited by 2 publications

(1 citation statement)

References 23 publications

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“…Importantly, this study had prespecified a modified Rankin Scale score as a primary exploratory outcome. However, this study managed to recruit only 14 patients, five of whom were lost to follow-up, rendering comparison between the treatment regimens unfeasible [48].…”

Section: Blood Pressure Variability Among Patients With Acute Ischaem...mentioning

confidence: 99%

Blood Pressure Variability in Acute Stroke: A Narrative Review

Zompola,

Palaiodimou,

Voumvourakis

et al. 2024

JCM

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The management of blood pressure variability (BPV) in acute stroke presents a complex challenge with profound implications for patient outcomes. This narrative review examines the role of BPV across various stages of acute stroke care, highlighting its impact on treatment strategies and prognostic considerations. In the prehospital setting, while guidelines lack specific recommendations for BP management, emerging evidence suggests a potential link between BPV and outcomes. Among ischaemic stroke patients who are ineligible for reperfusion therapies, BPV independently influences functional outcomes, emphasising the need for individualised approaches to BP control. During intravenous thrombolysis and endovascular therapy, the intricate interplay between BP levels, recanalisation status, and BPV is evident. Striking a balance between aggressive BP lowering and avoiding hypoperfusion-related complications is essential. Intracerebral haemorrhage management is further complicated by BPV, which emerges as a predictor of mortality and disability, necessitating nuanced BP management strategies. Finally, among patients with acute subarachnoid haemorrhage, increased BPV may be correlated with a rebleeding risk and worse outcomes, emphasizing the need for BPV monitoring in this population. Integration of BPV assessment into clinical practice and research protocols is crucial for refining treatment strategies that are tailored to individual patient needs. Future studies should explore novel interventions targeting BPV modulation to optimise stroke care outcomes.

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Section: Blood Pressure Variability Among Patients With Acute Ischaem...mentioning

confidence: 99%

Blood Pressure Variability in Acute Stroke: A Narrative Review

Zompola,

Palaiodimou,

Voumvourakis

et al. 2024

JCM

View full text Add to dashboard Cite

show abstract

Arterial blood pressure monitoring in stroke cohorts: the impact of reduced sampling rates to optimise remote patient monitoring

Ball,

Panerai,

Henstock

et al. 2024

Blood Pressure Monitoring

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Objective Remote patient monitoring (RPM) beat-to-beat blood pressure (BP) provides an opportunity to measure poststroke BP variability (BPV), which is associated with clinical stroke outcomes. BP sampling interval (SI) influences ambulatory BPV, but RPM BP SI optimisation research is limited. SI and RPM device capabilities require compromises, meaning SI impact requires investigation. Therefore, this study assessed healthy and stroke subtype BPV via optimised BP sampling, aiding sudden BP change identification and potentially assisting cardiovascular event (recurrent stroke) prediction. Methods Leicester Cerebral Haemodynamic Database ischaemic [acute ischaemic stroke (AIS), n = 68] and haemorrhagic stroke (intracerebral haemorrhage, n = 12) patient and healthy control (HC, n = 40) baseline BP data were analysed. Intrasubject and interpatient SD (SDi/SDp) represented individual/population variability with synthetically altered SIs. Matched-filter approaches using cross-correlation function detected sudden BP changes. Results At SIs between 1 and 180 s, SBP and DBP SDi staticised while SDp increased at SI < 30 s. Mean BP and HR SDi and SDp increased at SI < 60s. AIS BPV, normalised to SI1s, increased at SI30s (26%–131%) and SI120s (1%–274%). BPV increased concomitantly with SI. Cross-correlation analysis showed HC and AIS BP sudden change detection accuracy reductions with increasing SI. Positive BP deviation detection fell 48.48% (SI10s) to 78.79% (SI75s) in HC and 67.5% (SI10s) to 100% (SI75s) in AIS. Negative BP deviation detection fell 50% (SI10s) to 82.35% (SI75s) in HC and 52.27% (SI10s) to 95.45% (SI75s) in AIS. Conclusion Sudden BP change detection and BPV are relatively robust to SI increases within certain limits, but accuracy reductions generate unacceptable estimates, considerable within RPM device design. This research warrants further SI optimisation.

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A calcium channel or angiotensin converting enzyme inhibitor/angiotensin receptor blocker regime to reduced blood pressure variability in acute ischaemic stroke (CAARBS): A feasibility trial

Cited by 2 publications

References 23 publications

Blood Pressure Variability in Acute Stroke: A Narrative Review

Blood Pressure Variability in Acute Stroke: A Narrative Review

Arterial blood pressure monitoring in stroke cohorts: the impact of reduced sampling rates to optimise remote patient monitoring

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