Effects of antihypertensive treatment after acute stroke in the Continue Or Stop post-Stroke Antihypertensives Collaborative Study (COSSACS): a prospective, randomised, open, blinded-endpoint trial

Robinson, Thompson G.; Potter, John F.; Ford, Gary A.; Bulpitt, Christopher J.; Chernova, Julia; Jagger, Carol; James, Martin; Knight, J. David; Markus, Hugh S.; Mistri, Amit; Poulter, Neil

doi:10.1016/s1474-4422(10)70163-0

Cited by 227 publications

(142 citation statements)

References 31 publications

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“…6,[20][21][22][23][24] Enrolling patients in the prehospital phase may help to elucidate whether early BP management is beneficial in acute stroke. This is of particular interest in acute ICH, where the phenomenon of hematoma expansion, a well-known predictor of poor prognosis and mortality, 25 occurs most often within the first 3 hours from ICH onset.…”

Section: Relationship Of Prehospital Bp and Sbp On Ed Arrivalmentioning

confidence: 99%

Prehospital systolic blood pressure is higher in acute stroke compared with stroke mimics

et al. 2016

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Objective: To assess the natural history of prehospital blood pressure (BP) during emergency medical services (EMS) transport of suspected stroke and determine whether prehospital BP differs among types of patients with suspected stroke (ischemic stroke, TIA, intracerebral hemorrhage [ICH], or stroke mimic).Methods: A retrospective, cross-sectional, observational analysis of a centralized EMS database containing electronic records of patients transported by EMS to the emergency department (ED) with suspected stroke during an 18-month period was conducted. Hospital charts and neuroimaging were utilized to determine the final diagnosis (ischemic stroke, TIA, ICH, or stroke mimic). Conclusions: Prehospital SBP is higher in acute stroke relative to stroke mimics and highest in ICH. Given the stability of BP between initial EMS and ED measurements, it may be reasonable to test the feasibility and safety of prehospital antihypertensive therapy in patients with suspected acute stroke. Elevated hospital admission blood pressure (BP) in patients with acute stroke is common 1 and is associated with poor outcomes. [2][3][4][5] There is limited randomized clinical trial evidence that acute BP reduction improves outcomes after intracerebral hemorrhage (ICH). Results6 One of the hypothesized reasons for the modest treatment effect is that hematoma enlargement and clinical deterioration have already begun by the time antihypertensive therapy is administered. It has been suggested that initiation of BP reduction in the prehospital setting may improve the efficacy of this approach. Recent pilot studies have assessed the feasibility of a prehospital BP-lowering strategy in patients with acute stroke symptoms using topical glyceryl trinitrate 8 and sublingual lisinopril. 9 At this point, however, the natural history of BP in the prehospital setting in patients with acute stroke symptoms is poorly understood. In contrast, the course of BP after hospital admission has been well described. Pressures are highest at admission, begin to spontaneously decline almost immediately, 10 and this trend continues for several days.

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Section: Relationship Of Prehospital Bp and Sbp On Ed Arrivalmentioning

confidence: 99%

Prehospital systolic blood pressure is higher in acute stroke compared with stroke mimics

et al. 2016

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“…The patients were randomly assigned to either continue or stop antihypertensive drugs. At two weeks, there was no significant difference between groups for the primary outcome of death or dependency; the difference between the 'continue' and 'stop' groups for systolic (13 mmHg) and diastolic (8 mmHg) blood pressure was significant [14].…”

Section: Blood Pressure Management In Patients Not Receiving Thrombolmentioning

confidence: 79%

“…Studies on the management of hypertension in ischemic stroke have arrived at conflicting conclusions and only a few randomized trials of blood pressure lowering in acute ischemic stroke have been published [11][12][13][14][15].…”

Section: Blood Pressure Management In Patients Not Receiving Thrombolmentioning

confidence: 99%

Blood Pressure Control in Neurological ICU Patients: What is Too High and What is Too Low?

Zaidi¹

2013

TOCCMJ

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Abstract:The optimal blood pressure (BP) management in critically ill patients with neurological emergencies in the intensive care unit poses several challenges. Both over and under correction of the blood pressure are associated with increased morbidity and mortality in this population. Target blood pressures and therapeutic management are based on guidelines including those from the American Stroke Association and the Joint National Committee guidelines. We review these recommendations and the current concepts of blood pressure management in neurological emergencies. A variety of therapeutic agents including nicardipine, labetalol, nitroprusside are used for blood pressure management in patients with ischemic and hemorrhagic strokes. Currently, the role of inducing hypertension remains unclear. Hypertensive crises include hypertensive urgencies where elevated blood pressures are seen without end organ damage and can usually be managed by oral agents, and hypertensive emergencies where end organ damage is present and requires immediate treatment with intravenous drugs.

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“…An extensive literature of BP control trials in the acute phase never showed any advantage of BP lowering 32, 33, 34, 35, 36. However, these studies included intravenous tissue plasminogen activator (t‐PA)‐treated patients, where the arterial status was not systematically monitored during the reperfusion therapy.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Significance of Pulse Pressure Variability During Mechanical Thrombectomy in Acute Ischemic Stroke Patients

Maïer

Turc

Taylor

et al. 2018

JAHA

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BackgroundStudies on the role of blood pressure (BP) variability specifically during mechanical thrombectomy (MT) are sparse and limited. Moreover, pulse pressure (PP) has not been considered as a potent hemodynamic parameter to describe BP variability during MT. We assessed the impact of PP variability on functional outcome in acute ischemic stroke patients with large vessel occlusion during MT.Methods and ResultsAcute ischemic stroke patients presenting with large vessel occlusion from January 2012 to June 2016 were included. BP data during MT were prospectively collected in the ETIS (Endovascular Treatment in Ischemic Stroke) registry. Logistic regression models were used to assess the association between PP coefficients of variation and functional outcome at 3 months (modified Rankin Scale). Among the 343 included patients, PP variability was significantly associated with worse 3‐month modified Rankin Scale in univariable (odds ratio [OR]=1.56, 95% confidence interval [CI]: 1.24–1.96 per 1‐unit increase, P=0.0002) and multivariable ordinal logistic regression (adjusted OR=1.40, 95% CI: 1.09–1.79, P=0.008). PP variability was also associated with unfavorable outcome (modified Rankin Scale 3–6) in univariable (OR=1.53, 95% CI: 1.17–2.01, P=0.002) and multivariable analysis (adjusted OR=1.42, 95% CI: 1.02–1.98, P=0.04). There was an association between PP variability and 3‐month all‐cause mortality in univariable analysis (OR= 1.37, 95% CI: 1.01–1.85 per 1‐unit increase of the coefficient of variation of the PP, P=0.04), which did not remain significant after adjustment for potential confounders.Conclusions PP variability during MT is an independent predictor of worse clinical outcome in acute ischemic stroke patients. These findings support the need for a close monitoring of BP variability during MT. Whether pharmacological interventions aiming at reducing BP variability during MT could impact functional outcome needs to be determined.

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Effects of antihypertensive treatment after acute stroke in the Continue Or Stop post-Stroke Antihypertensives Collaborative Study (COSSACS): a prospective, randomised, open, blinded-endpoint trial

Cited by 227 publications

References 31 publications

Prehospital systolic blood pressure is higher in acute stroke compared with stroke mimics

Prehospital systolic blood pressure is higher in acute stroke compared with stroke mimics

Blood Pressure Control in Neurological ICU Patients: What is Too High and What is Too Low?

Prognostic Significance of Pulse Pressure Variability During Mechanical Thrombectomy in Acute Ischemic Stroke Patients

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