Blood Pressure Management in Acute Ischemic Stroke

Abstract

Purpose of Review Abrupt blood pressure (BP) rise is the most common clinical symptom of acute ischemic stroke (AIS). However, BP alterations during AIS reflect many diverse mechanisms, both stroke-related and nonspecific epiphenomena, which change over time and across patients. While extremes of BP as well as high BP variability have been related with worse outcomes in observational studies, optimal BP management after AIS remains challenging. Recent Findings This review discusses the complexity of the factors linking BP changes to the clinical outcomes of patients with AIS, depending on the treatment strategy and local vessel status and, in particular, the degree of reperfusion achieved. The evidence for possible additional clinical markers, including the presence of arterial hypertension, and comorbid organ dysfunction in individuals with AIS, as informative and helpful factors in therapeutic decision-making concerning BP will be reviewed, as well as recent data on neurovascular monitoring targeting person-specific local cerebral perfusion and metabolic demand, instead of the global traditional parameters (BP among others) alone. Summary The individualization of BP management protocols based on a complex evaluation of the homeostatic response to focal cerebral ischemia, including but not limited to BP changes, may be a valuable novel goal proposed in AIS, but further trials are warranted.

Adjunctive cytoprotective therapies in acute ischemic stroke: a systematic review

“…Targeting systemic haemodynamics alone is also not a promising strategy (also previously shown in a meta-analyse of blood pressure lowering agents by Sandset et al [16]) and appears even to have detrimental effects (found in 5/21 trials and shown in a sub-group analyse of the INWEST trial [167]). However, the link between blood pressure changes and clinical outcome in AIS patients is extremity complex and optimal blood pressure management remains challenging since it depends on treatment strategy, local vascular function and especially the degree of reperfusion or persistent occlusion (reviewed by Gasecki et al [168]). Only for one highly investigated compound, Nimodipine, 3 out of 10 trials showed a beneficial effect when given within 24 h of stroke onset.…”

Calenduloside E alleviates cerebral ischemia/reperfusion injury by preserving mitochondrial function

“…Stroke, one of the leading causes of death worldwide, is caused by the sudden blockage of blood flow or the rupture of blood vessels and can be divided into ischemic stroke and hemorrhagic stroke (Herpich and Rincon 2020;Shao et al 2020;Stinear et al 2020). Ischemic stroke accounts for approximately 70-85% of all strokes worldwide (Gąsecki et al 2020). After cerebral ischemia, intravenous thrombolysis in glucose-free DMEM solution at 37 °C for 0, 2, 4, 6, or 8 h, as previously described (Lai et al 2020).…”

Role of uroguanylin's signalling pathway in the development of ischaemic stroke

“…Stroke has been recognised as the leading cause of mortality and disability worldwide (Chen et al, 2019), and most cases (75%–80%) are due to ischaemic stroke (Gąsecki et al, 2020). It occurs when a blood clot (either a thrombus or an embolus) causes a significant reduction in blood flow to the brain (Bamford et al, 1991; Hossmann & Schuier, 1980), resulting in irreversible damage to neurons and glia.…”

“…The hypoperfused peri‐ischaemic region is characterised by the presence of electrophysiologically inactive, but still at least partially metabolically active neurons (González, 2006; Leigh et al, 2018). If blood flow is restored as soon as possible, the viability and function of cells in the peri‐ischaemic region can be salvaged; therefore, it has recently become the focus of numerous studies (Gąsecki et al, 2020).…”