High Blood Pressure in Acute Stroke and Subsequent Outcome

Abstract

Abstract-High blood pressure (BP) is common in acute stroke and might be associated with a poor outcome, although observational studies have given varying results. In a systematic review, articles were sought that reported both admission BP and outcome (death, death or dependency, death or deterioration, stroke recurrence, and hematoma expansion) in acute stroke. Data were analyzed by the Cochrane Review Manager software and are given as odds ratios (ORs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs Key Words: stroke, thrombotic Ⅲ stroke, hemorrhagic Ⅲ blood pressure Ⅲ morbidity Ⅲ mortality H igh blood pressure (BP Ͼ140/90 mm Hg, as defined by the World Health Organization) occurs in acute stroke in up to 75% of cases. 1,2 Subsequently, BP settles over a period of about a week, although Ϸ40% of patients remain hypertensive. The causes of this pathophysiologic response are multifactorial and are related to preexisting high BP, activation of the neuroendocrine systems (sympathetic nervous system, renin-angiotensin axis, and glucocorticoid system), increased cardiac output, and "white coat hypertension." [3][4][5][6][7] It has been suggested that high BP is associated with a poor outcome after acute stroke, although the results of observational studies have given conflicting results. Some authors have even demonstrated better outcomes in patients with high initial BP. 8,9 Data from the International Stroke Trial (IST) confirmed that the risk of early death and late death or dependency was independently associated with increasing systolic BP (SBP) in 17 398 patients. 10 We report here a systematic review of observational studies of BP and outcome and assess the relation between the two. Methods Study IdentificationPublished observational studies that reported baseline BP and outcome (death, death or dependency, or death or deterioration) or mechanisms for poor outcome (recurrent stroke, hemorrhagic transformation, development of cerebral edema, or hematoma expansion) in acute (Ͻ7 days) stroke were sought. Systematic searches of EMBASE and PUBMED were made by M.W. The search strategy used 10 key words: blood pressure, hypertension, outcome, prognosis, death, mortality, recovery, stroke, cerebr*, and acute. Additional studies were found from reference lists of identified articles and reviews. 11-13 Disability or dependency was typically measured with the Barthel Index or Rankin Scale; deterioration was defined as worsening on a stroke neurologic impairment scale, eg, National Institutes of Health stroke scale, or where an ordinal scale (eg, "improved," "unchanged," or "worse") was used. Publications were excluded if they were a randomized trial (these tend not to enroll consecutive patients and might therefore have a biased sample), gave insufficient data, used other outcomes, or were duplicate articles. Decisions on inclusion and exclusion of studies were made by M.W. and P.M.W.B. Data ExtractionTwo authors (M.W. and J.L.-B.) independently extracted data; discrepancies were resolved by P.M.W...

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Improving patient selection for endovascular treatment of acute cerebral ischemia: a review of the literature and an external validation of the Houston IAT and THRIVE predictive scoring systems

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Treatment Targets in Intracerebral Hemorrhage

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