Hypertension in Acute Ischemic Strokes

Spence, J. David; Maestro, Rolando F. Del

doi:10.1001/archneur.1985.04060090082019

Cited by 104 publications

(56 citation statements)

References 23 publications

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“…Additional studies were found from reference lists of identified articles and reviews. [11][12][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.…”

Section: Study Identificationmentioning

confidence: 99%

High Blood Pressure in Acute Stroke and Subsequent Outcome

2004

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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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Section: Study Identificationmentioning

confidence: 99%

High Blood Pressure in Acute Stroke and Subsequent Outcome

2004

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“…1 Concern about worsening of stroke with excessive lowering of blood pressure has been based to a large extent on inappropriate historical hypotensive therapies that cannot be controlled, such as "sublingual" nifedipine or intramuscular hydralazine. 2 As I pointed out with Del Maestro in 1985, 3 there are some circumstances in which severe hypertension must be treated in acute ischemic stroke. Two examples I have seen are aortic dissection picking off a renal and a carotid origin, with sudden severe renovascular hypertension, hypertensive encephalopathy in the territory of the patent carotid artery, and ischemia in the territory of the occluded internal carotid, and severe hypertension with acute pulmonary edema in the setting of myocardial ischemia, with acute embolic stroke from the myocardial infarction.…”

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Treating Hypertension in Acute Ischemic Stroke

Spence

2009

Hypertension

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“…Outro fator agravante é o edema tissular secundário ao episódio isquêmico. Este leva ao aumento da pressão tissular, o que interfere na circulação colateral 7,10,12 .…”

Section: Discussionunclassified

“…Apesar do declínio ocorrido nas últimas décadas 2 , ainda é a doença neurológica de maior morbidade e a terceira principal causa de morte dentre as doenças no Brasil e nos países ocidentais [1][2][3][4][5][6][7] .…”

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Manejo da hipertensão arterial na isquemia cerebral aguda

Fagundes-Pereyra

Ramos

Malheiro

et al. 1999

Arq. Neuro-Psiquiatr.

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quadro de hipertensão arterial na fase aguda da isquemia cerebral. Também comentamos as principais condutas nesta fase, com ênfase na tensão arterial (TA). Método: Foram entrevistados 120 médicos da clínica médica e da cirurgia geral, em dez dos maiores Hospitais de Belo Horizonte, em 1997. Todos responderam a um questionário contendo um caso clínico de paciente hipertenso leve, admitido com quadro de isquemia cerebral e tensão arterial de 186x110 mmHg. Os profissionais deveriam optar por reduzir, aumentar ou manter a TA. Resultados: Dos entrevistados, 38 (31,7%) responderam que reduziriam os níveis tensionais, 82 (68,3%) optaram pela manutenção e nenhum aumentaria (p<0,05). Estes índices foram iguais nas duas especialidades. Já em relação ao tempo de formado, observou-se que aqueles com mais de 10 anos de graduação, apresentaram maior tendência a redução da TA (p<0,05), quando comparado aos mais jovens. Conclusão: A redução da TA prejudica a perfusão cerebral, podendo aumentar a área isquêmica ("zona de penumbra"). Concluimos que, apesar de estar a maioria dos médicos ciente da conduta recomendada no manejo da hipertensão arterial na fase aguda dos quadros isquêmios cerebrais 31,7% ainda é uma taxa elevada de médicos despreparados para o atendimento emergencial de isquemia cerebral, considerando os prejuízos trazidos ao paciente em decorrência da conduta inadequada. Talvez o desenvolvimento de unidades especializadas no atendimento desses pacientes ("stroke units") possa melhorar tais índices. PALAVRAS-CHAVE: isquemia cerebral, hipertensão arterial, terapêutica. Management of arterial hypertension in patients with acute ischemic strokeABSTRACT -Purpose: We aimed with study to assess the current clinical practice about the management of high blood pressure in patients in the acute phase of ischemic stroke. We also comment some topics of ischemic stroke treatment. Methods: A case report of a patient admitted 8 hours after onset of ischemic stroke and with blood pressure of 186x110 mmHg was presented to 120 surgeons and clinician. They were asked to decide the best therapeutic option: to increase, decrease or maintenance blood pressure. Results: Thirty-eight physicians (31,7%) considered decreasing blood pressure the best therapeutics, 82 (68,3%) considered maintenance and none decided to increase it (p < 0.05). There was no difference between the two specialties conduct. The physicians, with more than 10 years of graduation, had a tendency to decrease the blood pressure (p <0.05). Conclusion: The maintenance of blood pressure may present a sufficient blood support to compensate brain flow. A high percentage of the physicians (31,7%) do not know about the current concepts of therapeutics considering hypertension in acute ischemic stroke. The development on special units to treat these patients ("stroke units") may eventually decrease the morbimortality rates of ischemic stroke.

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Hypertension in Acute Ischemic Strokes

Cited by 104 publications

References 23 publications

High Blood Pressure in Acute Stroke and Subsequent Outcome

High Blood Pressure in Acute Stroke and Subsequent Outcome

Treating Hypertension in Acute Ischemic Stroke

Manejo da hipertensão arterial na isquemia cerebral aguda

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