Effect of Blood Pressure During the Acute Period of Ischemic Stroke on Stroke Outcome

Aslanyan, Stella; Fazekas, Franz; Weir, Christopher J.; Horner, Susanna; Lees, Kennedy R.

doi:10.1161/01.str.0000091233.04524.0c

Cited by 136 publications

(102 citation statements)

References 26 publications

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“…However, these unselected data suggest closer control of postthrombolysis systolic BP. Our findings are consistent with an intravenous thrombolysis study 31 and a rather large study in general stroke patients (nϭ1455) 32 but not with smaller studies (n Ͻ400). 33,34 In our study, BP was measured according to usual clinical practice.…”

Section: Discussionsupporting

confidence: 90%

Relationship of Blood Pressure, Antihypertensive Therapy, and Outcome in Ischemic Stroke Treated With Intravenous Thrombolysis

Ahmed

Wahlgren

Brainin

et al. 2009

Stroke

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332

136

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Section: Discussionsupporting

confidence: 90%

Relationship of Blood Pressure, Antihypertensive Therapy, and Outcome in Ischemic Stroke Treated With Intravenous Thrombolysis

Ahmed

Wahlgren

Brainin

et al. 2009

Stroke

Self Cite

332

136

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“…There was spontaneous reduction of blood pressure (an average of 20 mm Hg systolic and 10 mm Hg diastolic) within ten days following the acute event without any specific antihypertensive therapy, with only one third of the cases remaining hypertensive on the tenth day of hospitalization. Subsequently, several other studies [2][3][4][5][6][7][8] have also described elevation of blood pressure in the acute period of stroke. In a systematic review of 18 studies [9], 52% of the patients with stroke had elevated blood pressure at the time of admission.…”

mentioning

confidence: 98%

Prevalence of elevated blood pressure in 563704 adult patients with stroke presenting to the ED in the United States

Qureshi¹,

Ezzeddine²,

Nasar³

et al. 2007

The American Journal of Emergency Medicine

397

245

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Purpose-To estimate the prevalence of elevated blood pressure in adult patients with acute stroke in the United States (U.S.).Methods-Stroke patients were classified by initial systolic blood pressure into four categories using demographic, clinical, and treatment data from the National Hospital Ambulatory Medical Care Survey, the largest study of utilization and provision of emergency department services in the U.S. We also compared the age-, sex-, and ethnicity-adjusted rates of elevated blood pressure strata comparable with stages 1 and 2 hypertension in the U.S. population.Results-Of the 563,704 stroke patients evaluated, initial systolic blood pressure was <140 mm Hg in 173,120 patients (31%), 140-184 mm Hg in 315,207 patients (56%), 185-219 mm Hg in 74,586 patients (13%), and ≥220 mm Hg in 791 patients (0.1%). The mean time interval between presentation and evaluation was 40 ± 55, 33 ± 39, 25 ± 27, and 5 ± 1 minutes for increasing systolic blood pressure strata (p=0.009). A 3-and 8-fold higher rate of elevated blood pressure strata was observed in acute stroke than the existing rates of stages 1 and 2 hypertension in the U.S. population. Labetalol and hydralazine were used in 6,126 (1%) and 2,262 (0.4%) patients, respectively. Thrombolytics were used in 1,283 patients (0.4%), but only in those with SBP of 140-184 mm Hg.Conclusions-In a nationally representative large dataset, elevated blood pressure was observed in over 60% of the patients presenting with stroke to the emergency department. Elevated blood pressure was associated with an earlier evaluation, however, the use of thrombolytics was restricted to ischemic stroke patients with systolic blood pressure <185 mm Hg.

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“…A retrospective analysis of blood pressure data from the Glycine Antagonist in Neuroprotection International (GAIN) Trial found that 11% of the 1455 patients had a 30% decrease in mean arterial pressure over the first 2.5 days, with no independent effect on 3-month outcome. 43 It is not clear whether blood pressure decreased precipitously in these patients. Those patients (6%) that had a 30% increase in mean arterial blood pressure over this same period had significantly poorer outcome.…”

Section: Discussionmentioning

confidence: 96%

“…1,50 Further, the retrospective data previously reviewed suggest that patients having a significant increase in blood pressure over the first days after ischemic stroke may have poorer outcomes. 43 Although rapid acute blood pressure reductions need to be avoided, there may be potential benefit from acute antihypertensive therapy. A double-blind, placebo-controlled, multicenter phase II study (Acute Candestartan Cilexetil Therapy in Stroke Survivors [ACCESS] Study) randomized 342 hypertensive patients with ischemic stroke to candesartan cilexetil over the first 7 days, targeting a 10% to 15% reduction in blood pressure in the first 24 hours or placebo.…”

Section: Discussionmentioning

confidence: 99%

Blood Pressure Management in Patients With Acute Ischemic Stroke

Goldstein

2004

Hypertension

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A 68-year-old right-hand-dominant man was brought to the hospital because of a speech disturbance and right arm and leg weakness. He awoke with these deficits and was last known to be symptom-free when retiring to bed the previous evening 8 hours earlier. His past medical history was notable for coronary heart disease, the patient having underwent coronary artery bypass surgery 7 years previously for unstable angina, but he had no known history of myocardial infarction. He also had hypertension and hyperlipidemia, and smoked 1 pack of cigarettes daily for more than 40 years. He had no history of calf claudication. His hypertension was being treated with a diuretic and ␤-adrenergic receptor blocker. He was also prescribed 325 mg of aspirin daily and an HMG CoA-reductase inhibitor (statin); however, his wife remarked that he often forgot to take his medications. His last total cholesterol was 240 mg/dL, with LDL cholesterol of 130 mg/dL. He had a strong family history of coronary heart disease after the age of 50. He had no known drug allergies. Physical ExaminationThe patient's blood pressure was 195/100 mm Hg in both arms, with a regular pulse of 90 bpm. His weight was 225 lb (body mass index: 31.4 kg/m 2 ). His lungs were clear to auscultation. Cardiac examination showed a laterally displaced point of maximum impulse with an S 4 gallop and a soft nonradiating systolic murmur at the base. His abdomen was obese without organomegaly and no abdominal bruits were detected. He had no rashes and no joint deformities. The left superficial temporal artery pulse was stronger than the right. There were soft bilateral anterior cervical bruits, left louder than right, but no supraclavicular bruits. There were bilateral femoral bruits. Radial pulses were 2 ϩ and symmetric. Dorsalis pedis and posterior tibial pulses were 1 ϩ . There was no pretibial or ankle edema. Neurological ExaminationThe patient was alert. He spoke haltingly and made frequent paraphasic errors, using inappropriate words and occasional neologisms. He was able to follow simple verbal commands but had difficulty with repetitions. Further cognitive evaluation could not be performed because of the language disturbance. Cranial nerve examination revealed a right homonymous visual field deficit to threat. Funduscopic examination disclosed arteriolar narrowing with arteriolar-venous nicking, but no hemorrhages. There were no Hollenhorst plaques. There was a left gaze preference with otherwise full extraocular movements and no nystagmus. Pupillary light reflexes were normal. The right corneal response was diminished and there was a mild right lower facial paresis. His gag response was absent and his tongue deviated to the right. Motor examination revealed normal bulk with diminished tone in his right arm. He had 3/5 proximal and 2/5 distal strength in the right arm, 4/5 strength in the right leg, and full strength in his left arm and leg. He had a coordination deficit consistent with the weakness in his right arm and leg and normal coordination on the left. Senso...

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Effect of Blood Pressure During the Acute Period of Ischemic Stroke on Stroke Outcome

Cited by 136 publications

References 26 publications

Relationship of Blood Pressure, Antihypertensive Therapy, and Outcome in Ischemic Stroke Treated With Intravenous Thrombolysis

Relationship of Blood Pressure, Antihypertensive Therapy, and Outcome in Ischemic Stroke Treated With Intravenous Thrombolysis

Prevalence of elevated blood pressure in 563704 adult patients with stroke presenting to the ED in the United States

Blood Pressure Management in Patients With Acute Ischemic Stroke

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