Acute Blood Pressure Levels and Neurological Deterioration in Different Subtypes of Ischemic Stroke

Abstract

Background and Purpose-The purpose of this study was to determine at which time points acute blood pressure (BP) was associated with neurological deterioration at 3 weeks in patients with ischemic stroke as a whole and in patients with different subtypes. Methods-BP was measured every 6 hours for the first 36 hours of emergent hospitalization in 565 consecutive patients (347 men, 70Ϯ11 years in age) presenting within 24 hours of an acute ischemic stroke. Neurological deterioration was defined as a Ն2-point increase in the National Institutes of Health stroke scale (NIHSS) score at 3 weeks compared to the admission score. Results-At 3 weeks, 64 patients (11.3%) had deteriorated neurologically. For the group as a whole, high systolic BP (SBP) values measured at 12, 18, 24, and 36 hours postadmission were independently related to neurological deterioration after adjustment for age, sex, and known predictors, including admission NIHSS score, admission blood glucose level, and large infarct size. At 24 hours, the odds of neurological deterioration increased by 20% per 10-mm Hg increase in SBP. For cardioembolic stroke patients, high SBP values measured at 12 through 36 hours were independently related to neurological deterioration after multivariate adjustment. For patients having stroke other than cardioembolism, no SBP values at any time point were related to neurological deterioration. Conclusions-Acute SBP values between 12 and 36 hours postadmission, but not those on admission or at 6 hours, were predictive of neurological deterioration within the initial 3 weeks of ischemic stroke, particularly for cardioembolic stroke patients.

Prognostic Significance of Short-Term Blood Pressure Variability in Acute Stroke

“…Seven studies were of a prospective observational nature, [13][14][15][16][17][18][19] 5 were observational analyses of prospective stroke registry data, [20][21][22][23][24] and 6 were observational analyses of previous randomized controlled trial data. [25][26][27][28][29][30] Study sample size varied from 71 to 2645 participants. Eight studies were deemed suitable to include in the meta-analysis for effect of BPV on functional outcome.…”

What Change in the National Institutes of Health Stroke Scale Should Define Neurologic Deterioration in Acute Ischemic Stroke?

“…2 Neurologic deterioration (ND), an event that occurs in about one-third of patients with acute ischemic stroke (AIS) and contributes to morbidity and mortality, 10,11 has no standardized definition. 12 Currently, clinical studies use inconsistent definitions of ND with differing stroke scales in order to quantify clinical worsening over days, [13][14][15][16] weeks, 17 or months 18 ( Table 1). Some definitions of ND might be too narrow 19,20 and may exclude patients whose neurologic function may be recoverable, while other definitions may be too broad 14,21 and could prompt the unnecessary work-up of false-positive episodes of ND.…”

Perfusion-weighted MRI parameters for prediction of early progressive infarction in middle cerebral artery occlusion

“…sified as those individuals experiencing neurological deterioration (NIHSS score increased by more than 2 points during 24 hours) 7,17,31) . In addition, MR diffusion images showed an aggravated infarction compared with the initial image.…”