Blood pressure during the first minutes of focal cerebral ischemia

Broderick, Joseph P.; Brott, Thomas G.; Bersan, William; Haley, E. Clarke; Levy, David E.; Marter, John; Sheppard, George L.; Blum, C

doi:10.1016/s0196-0644(05)81993-6

Cited by 104 publications

(55 citation statements)

References 20 publications

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“…O primeiro instinto de alguns clínicos e intensivistas é tratar. Torna-se portanto, importante ressaltar que a redução dos níveis tensionais acentua a queda do fluxo sanguíneo nesta área, e isso agrava a isquemia 15,18 . Assim, a redução da TA, quando necessária, o que é raro, deve ser cuidadosa, evitando-se que FSC diminua, de modo a não aumentar ainda mais a área isquêmica.…”

Section: Discussionunclassified

“…Entretanto, somente um terço destes permaneceram hipertensos após dez dias de acompanhamento. Esses achados são corroborados por Broderick et al, que vão mais além, mostrando que em mais de 80% dos pacientes a TA diminui dentro das primeiras horas do ictus 18 . Se está planejada a terapia com trombolíticos, o controle da TA deve ser rigoroso, visando reduzir o risco potencial de sangramento após sua administração 15,18 .…”

Section: Discussionunclassified

“…Esses achados são corroborados por Broderick et al, que vão mais além, mostrando que em mais de 80% dos pacientes a TA diminui dentro das primeiras horas do ictus 18 . Se está planejada a terapia com trombolíticos, o controle da TA deve ser rigoroso, visando reduzir o risco potencial de sangramento após sua administração 15,18 . Esta terapia não é recomendada se a TA sistólica é maior que 185 ou se a TA diastólica é maior que 110 mmHg 15,22 .…”

Section: Discussionunclassified

“…Assim, não havia indicação formal para redução imediata da TA à luz dos conhecimentos atuais 7,8,9,18,20,23 .…”

Section: Discussionunclassified

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Manejo da hipertensão arterial na isquemia cerebral aguda

Fagundes-Pereyra

Ramos

Malheiro

et al. 1999

Arq. Neuro-Psiquiatr.

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quadro de hipertensão arterial na fase aguda da isquemia cerebral. Também comentamos as principais condutas nesta fase, com ênfase na tensão arterial (TA). Método: Foram entrevistados 120 médicos da clínica médica e da cirurgia geral, em dez dos maiores Hospitais de Belo Horizonte, em 1997. Todos responderam a um questionário contendo um caso clínico de paciente hipertenso leve, admitido com quadro de isquemia cerebral e tensão arterial de 186x110 mmHg. Os profissionais deveriam optar por reduzir, aumentar ou manter a TA. Resultados: Dos entrevistados, 38 (31,7%) responderam que reduziriam os níveis tensionais, 82 (68,3%) optaram pela manutenção e nenhum aumentaria (p<0,05). Estes índices foram iguais nas duas especialidades. Já em relação ao tempo de formado, observou-se que aqueles com mais de 10 anos de graduação, apresentaram maior tendência a redução da TA (p<0,05), quando comparado aos mais jovens. Conclusão: A redução da TA prejudica a perfusão cerebral, podendo aumentar a área isquêmica ("zona de penumbra"). Concluimos que, apesar de estar a maioria dos médicos ciente da conduta recomendada no manejo da hipertensão arterial na fase aguda dos quadros isquêmios cerebrais 31,7% ainda é uma taxa elevada de médicos despreparados para o atendimento emergencial de isquemia cerebral, considerando os prejuízos trazidos ao paciente em decorrência da conduta inadequada. Talvez o desenvolvimento de unidades especializadas no atendimento desses pacientes ("stroke units") possa melhorar tais índices. PALAVRAS-CHAVE: isquemia cerebral, hipertensão arterial, terapêutica. Management of arterial hypertension in patients with acute ischemic strokeABSTRACT -Purpose: We aimed with study to assess the current clinical practice about the management of high blood pressure in patients in the acute phase of ischemic stroke. We also comment some topics of ischemic stroke treatment. Methods: A case report of a patient admitted 8 hours after onset of ischemic stroke and with blood pressure of 186x110 mmHg was presented to 120 surgeons and clinician. They were asked to decide the best therapeutic option: to increase, decrease or maintenance blood pressure. Results: Thirty-eight physicians (31,7%) considered decreasing blood pressure the best therapeutics, 82 (68,3%) considered maintenance and none decided to increase it (p < 0.05). There was no difference between the two specialties conduct. The physicians, with more than 10 years of graduation, had a tendency to decrease the blood pressure (p <0.05). Conclusion: The maintenance of blood pressure may present a sufficient blood support to compensate brain flow. A high percentage of the physicians (31,7%) do not know about the current concepts of therapeutics considering hypertension in acute ischemic stroke. The development on special units to treat these patients ("stroke units") may eventually decrease the morbimortality rates of ischemic stroke.

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Section: Discussionunclassified

“…Assim, não havia indicação formal para redução imediata da TA à luz dos conhecimentos atuais 7,8,9,18,20,23 .…”

Section: Discussionunclassified

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Manejo da hipertensão arterial na isquemia cerebral aguda

Fagundes-Pereyra

Ramos

Malheiro

et al. 1999

Arq. Neuro-Psiquiatr.

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“…Management guidelines that have been proposed including JNC VI recommendations have been based on consensus statements rather than controlled trial evidence, and recommended treatment only for severe (180-220/110-120 mm Hg on repeated measurements) or complicated hypertension (cardiac failure or arterial dissection) after acute stroke. [12][13][14][15][16] The strikingly lower rate of haemorrhagic transformation within the National Institute of Neurological Disorders and Stroke rt-PA study 17 may be related to the exclusion of patients with uncontrolled hypertension, reinforcing the theoretical view that haemorrhagic transformation or cerebral oedema may be exacerbated by hypertension. This provides some rationale for BP control in the early hours or days after stroke which, taken with the evidence favouring long-term BP control, suggests that there may be an optimal time and degree of BP reduction that has yet to be established.…”

Section: Introductionmentioning

confidence: 99%

Prior antihypertensive treatment and admission blood pressure correlated with clinical outcome and early morning presentation in hypertensive ischaemic stroke patients

et al. 1999

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Blood pressure (BP) reduction of 5-6 mm Hg reduces the relative risk of stroke by 30-40%. This effect does not appear to depend on the antihypertensive agent used to bring about the required reduction in BP. Patients with acute ischaemic stroke often exhibit an elevated BP. These patients, who previously suffered from hypertension, have significantly higher levels of BP readings on admission with increased incidence of stroke immediately after arising. The aim of this study was to compare antihypertensive agents, especially short and long acting drugs with the measurement of BP on admission, the time of the ischaemic stroke and its clinical severity. This was studied retrospectively in 109 patients (55 females and 54 males). The mean age

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Public Perception of Stroke Warning Signs and Knowledge of Potential Risk Factors

Pancioli¹

1998

JAMA

464

404

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Context.-Decreasing the time from stroke onset to hospital arrival and improving control of stroke risk factors depend on public knowledge of stroke warning signs and risk factors.Objective.-To assess current public knowledge of stroke warning signs and risk factors.Design.-A population-based telephone interview survey using random digit dialing conducted in 1995.Setting.-The Greater Cincinnati, Ohio, metropolitan area, the population of which is similar to that of the United States overall in age, sex, percentage of blacks, and economic status.Participants.-Respondents with age, race, and sex that matched the population of patients with acute stroke.Main Outcome Measures.-Knowledge of risk factors for stroke and warning signs of stroke as defined by the National Institute of Neurological Disorders and Stroke.Results.-Telephone calls were made to 17 634 households, which yielded 2642 demographically eligible individuals. Interviews were completed by 1880 respondents (response rate, 71.2%). A total of 1066 respondents (57%) correctly listed at least 1 of the 5 established stroke warning signs, and of all respondents, 1274 (68%) correctly listed at least 1 of the established stroke risk factors. Of the respondents, 469 (57%) of 818 respondents with a history of hypertension listed hypertension, 142 (35%) of 402 respondents who were current smokers listed smoking, and 32 (13%) of 255 respondents with diabetes listed diabetes as a risk factor for stroke. Compared with those younger than 75 years, respondents 75 years or older were less likely to correctly list at least 1 stroke warning sign (60% vs 47%, respectively; PϽ.001) and were less likely to list at least 1 stroke risk factor (72% vs 56%, respectively; PϽ.001).Conclusion.-Considerable education is needed to increase the public's awareness of the warning signs and risk factors for stroke. Respondents with selfreported risk factors for stroke are largely unaware of their increased risk. The population at greatest risk for stroke, the very elderly, are the least knowledgeable about stroke warning signs and risk factors.

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Blood pressure during the first minutes of focal cerebral ischemia

Cited by 104 publications

References 20 publications

Manejo da hipertensão arterial na isquemia cerebral aguda

Manejo da hipertensão arterial na isquemia cerebral aguda

Prior antihypertensive treatment and admission blood pressure correlated with clinical outcome and early morning presentation in hypertensive ischaemic stroke patients

Public Perception of Stroke Warning Signs and Knowledge of Potential Risk Factors

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