Factors influencing acute blood pressure values in stroke subtypes

Abstract

The aim of this prospective observational study was to determine the association of acute blood pressure values with independent factors (demographic, clinical characteristics, early complications) in stroke subgroups of different aetiology. We evaluated data of 346 first-ever acute (o24 h) stroke patients treated in our stroke unit. Casual and 24-h blood pressure (BP) values were measured. Stroke risk factors and stroke severity on admission were documented. Strokes were divided into subgroups of different aetiopathogenic mechanism. Patients were imaged with CT-scan on admission and 5 days later to determine the presence of brain oedema and haemorrhagic transformation. The relationship of different factors to 24-h BP values (24-h BP) was evaluated separately in each stroke subgroup. In large artery atherosclerotic stroke (n ¼ 59), history of hypertension and stroke severity correlated with higher 24-h BP respectively. In cardioembolic stroke (n ¼ 87), history of hypertension, stroke severity, haemorrhagic transformation and brain oedema were associated with higher 24-h BP, while heart failure with lower 24-h BP. History of hypertension and coronary artery disease was related to higher and lower 24-h BP, respectively, in lacunar stroke (n ¼ 75). In patients with infarct of undetermined (n ¼ 57) cause 24-h BP were mainly influenced by stroke severity and history of hypertension. An independent association between higher 24-h BP and history of hypertension and cerebral oedema was documented in intracerebral haemorrhage (n ¼ 68). In conclusion, different factors influence acute BP values in stroke subtypes of different aetiology. If the clinical significance of these observations is verified, a differentiated approach in acute BP management based on stroke aetiology may be considered.

Acute Blood Pressure Levels and Neurological Deterioration in Different Subtypes of Ischemic Stroke

“…9 -12 Massive edema and hemorrhagic transformation are characteristic findings of cardioembolic stroke, and they were reported to have a relationship with higher 24-hour BP in cardioembolic stroke. 13 These findings may explain the relationship between high SBP values measured at 12 through 36 hours and poor outcome in the present cardioembolic patients. In contrast, because atherothrombotic stroke patients often have a hemodynamic crisis, and maintenance of collateral blood flow to the ischemic penumbra is necessary during acute days, elevated BP may be protective against ischemic lesions.…”

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

“…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. This is likely to be less accurate than rigorously controlled methods and will therefore underestimate any true difference between groups or change over time.…”

Guidelines for the Early Management of Patients With Acute Ischemic Stroke

“…In a study of 930 patients with acute ischemic stroke, the admission systolic blood pressure was <100 mm Hg in only 2.5% of the patients, and this was associated with ischemic heart disease. 412 In a study of 11 080 patients treated with intravenous rtPA for acute ischemic stroke, the admission systolic blood pressure was <100 mm Hg in only 64 (0.6%) of the patients. 434 The brain is especially vulnerable to arterial hypotension during acute ischemic stroke because of impaired cerebral autoregulation.…”

“…Blood pressure typically decreases spontaneously during the acute phase of ischemic stroke, starting within 90 minutes after onset of stroke symptoms. [408][409][410][411][412][413][414] Extreme arterial hypertension is clearly detrimental, because it leads to encephalopathy, cardiac complications, and renal insufficiency. Theoretically, moderate arterial hypertension during acute ischemic stroke might be advantageous by improving cerebral perfusion of the ischemic tissue, or it might be detrimental by exacerbating edema and hemorrhagic transformation of the ischemic tissue.…”

“…412,[415][416][417]434 The exact definition of arterial hypotension needs to be individualized. In a given patient, a blood pressure that is lower during acute ischemic stroke than the premorbid pressure could be considered hypotension.…”