Acute hypertensive response in patients with intracerebral hemorrhage pathophysiology and treatment

Qureshi, Adnan I; Qureshi, Mushtaq

doi:10.1177/0271678x17725431

Cited by 33 publications

(23 citation statements)

References 100 publications

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“…Hypertension is the most frequent comorbidity associated with CNS injuries (Abraham et al ., 2016; Qureshi and Qureshi, 2017). Hypertension is evident in up to 70% of stroke patients (Staessen et al ., 2003).…”

Section: Pparγ Protects Against Comorbiditiesmentioning

confidence: 99%

Peroxisome proliferator-activated receptor γ (PPARγ): A master gatekeeper in CNS injury and repair

Cai

Yang

Liu

et al. 2018

Progress in Neurobiology

184

147

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Peroxisome proliferator-activated receptor γ (PPARγ) is a widely expressed ligand-modulated transcription factor that governs the expression of genes involved in inflammation, redox equilibrium, trophic factor production, insulin sensitivity, and the metabolism of lipids and glucose. Synthetic PPARγ agonists (e.g. thiazolidinediones) are used to treat Type II diabetes and have the potential to limit the risk of developing brain injuries such as stroke by mitigating the influence of comorbidities. If brain injury develops, PPARγ serves as a master gatekeeper of cytoprotective stress responses, improving the chances of cellular survival and recovery of homeostatic equilibrium. In the acute injury phase, PPARγ directly restricts tissue damage by inhibiting the NFκB pathway to mitigate inflammation and stimulating the Nrf2/ARE axis to neutralize oxidative stress. During the chronic phase of acute brain injuries, PPARγ activation in injured cells culminates in the repair of gray and white matter, preservation of the blood-brain barrier, reconstruction of the neurovascular unit, resolution of inflammation, and long-term functional recovery. Thus, PPARγ lies at the apex of cell fate decisions and exerts profound effects on the chronic progression of acute injury conditions. Here, we review the therapeutic potential of PPARγ in stroke and brain trauma and highlight the novel role of PPARγ in long-term tissue repair. We describe its structure and function and identify the genes that it targets. PPARγ regulation of inflammation, metabolism, cell fate (proliferation/differentiation/maturation/survival), and many other processes also has relevance to other neurological diseases. Therefore, PPARγ is an attractive target for therapies against a number of progressive neurological disorders.

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Section: Pparγ Protects Against Comorbiditiesmentioning

confidence: 99%

Peroxisome proliferator-activated receptor γ (PPARγ): A master gatekeeper in CNS injury and repair

Cai

Yang

Liu

et al. 2018

Progress in Neurobiology

184

147

View full text Add to dashboard Cite

show abstract

“…Spontaneous intracerebral hemorrhage (SICH) remains a devastating disease without effective therapies, with only approximately 20% of patients achieving functional independence at 6 months ( van Asch et al, 2010 ). Recent studies have shown that the prognosis of SICH varies with the location of the haematoma, and clinical trials on this disease have begun to develop novel SICH treatments to target various populations to maximize treatment benefits ( Anderson et al, 2010 ; Fu et al, 2014 ; Sreekrishnan et al, 2016 ; Qureshi and Qureshi, 2018 ). To better make clinical decisions for these candidate therapies, it is essential to derive effective and reliable prognostic tools for the prognostic risk assessment of SICH.…”

Section: Introductionmentioning

confidence: 99%

Location-Specific Radiomics Score: Novel Imaging Marker for Predicting Poor Outcome of Deep and Lobar Spontaneous Intracerebral Hemorrhage

Zhou

Song

et al. 2021

Front. Neurosci.

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Objective: To derive and validate a location-specific radiomics score (Rad-score) based on noncontrast computed tomography for predicting poor deep and lobar spontaneous intracerebral hemorrhage (SICH) outcome.Methods: In total, 494 SICH patients from multiple centers were retrospectively reviewed. Poor outcome was considered mRS 3–6 at 6 months. The Rad-score was derived using optimal radiomics features. The optimal location-specific Rad-score cut-offs for poor deep and lobar SICH outcomes were identified using receiver operating characteristic curve analysis. Univariable and multivariable analyses were used to determine independent poor outcome predictors. The combined models for deep and lobar SICH were constructed using independent predictors of poor outcomes, including dichotomized Rad-score in the derivation cohort, which was validated in the validation cohort.Results: Of 494 SICH patients, 392 (79%) had deep SICH, and 373 (76%) had poor outcomes. The Glasgow Coma Scale score, haematoma enlargement, haematoma location, haematoma volume and Rad-score were independent predictors of poor outcomes (all P < 0.05). Cut-offs of Rad-score, 82.90 (AUC = 0.794) in deep SICH and 80.77 (AUC = 0.823) in lobar SICH, were identified for predicting poor outcomes. For deep SICH, the AUCs of the combined model were 0.856 and 0.831 in the derivation and validation cohorts, respectively. For lobar SICH, the combined model AUCs were 0.866 and 0.843 in the derivation and validation cohorts, respectively.Conclusion: Location-specific Rad-scores and combined models can identify subjects at high risk of poor deep and lobar SICH outcomes, which could improve clinical trial design by screening target patients.

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“…Differences may be explained by the variation in intensity of SBP reduction between trials. A treatment threshold of SBP ≥180 mm with the target goal of reduction to 130–150 mmHg within 6 h of symptom onset may be best choice [ 152 ].…”

Section: Discussionmentioning

confidence: 99%

Hypertensive Crisis in Acute Cerebrovascular Diseases Presenting at the Emergency Department: A Narrative Review

Cantone¹,

Lanza

Puglisi

et al. 2021

Brain Sciences

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Hypertensive crisis, defined as an increase in systolic blood pressure >179 mmHg or diastolic blood pressure >109 mmHg, typically causes end-organ damage; the brain is an elective and early target, among others. The strong relationship between arterial hypertension and cerebrovascular diseases is supported by extensive evidence, with hypertension being the main modifiable risk factor for both ischemic and hemorrhagic stroke, especially when it is uncontrolled or rapidly increasing. However, despite the large amount of data on the preventive strategies and therapeutic measures that can be adopted, the management of high BP in patients with acute cerebrovascular diseases presenting at the emergency department is still an area of debate. Overall, the outcome of stroke patients with high blood pressure values basically depends on the occurrence of hypertensive emergency or hypertensive urgency, the treatment regimen adopted, the drug dosages and their timing, and certain stroke features. In this narrative review, we provide a timely update on the current treatment, debated issues, and future directions related to hypertensive crisis in patients referred to the emergency department because of an acute cerebrovascular event. This will also focus greater attention on the management of certain stroke-related, time-dependent interventions, such as intravenous thrombolysis and mechanic thrombectomy.

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Acute hypertensive response in patients with intracerebral hemorrhage pathophysiology and treatment

Cited by 33 publications

References 100 publications

Peroxisome proliferator-activated receptor γ (PPARγ): A master gatekeeper in CNS injury and repair

Peroxisome proliferator-activated receptor γ (PPARγ): A master gatekeeper in CNS injury and repair

Location-Specific Radiomics Score: Novel Imaging Marker for Predicting Poor Outcome of Deep and Lobar Spontaneous Intracerebral Hemorrhage

Hypertensive Crisis in Acute Cerebrovascular Diseases Presenting at the Emergency Department: A Narrative Review

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