Prognostic value of blood pressure in acute stroke

Boreas, Anita; Lodder, J.; Kessels, Fons; Leeuw, Peter W. de; Troost, J.

doi:10.1038/sj.jhh.1001304

Cited by 41 publications

(26 citation statements)

References 31 publications

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“…415,421,422,424,428,429 Three studies found that decreases in blood pressure were associated with poor clinical outcomes. 415,421,428 Two studies found no association between blood pressure fluctuations and clinical outcomes. 424,429 One study found that decreases in blood pressure were associated with favorable clinical outcome.…”

Section: March 2013mentioning

confidence: 99%

Guidelines for the Early Management of Patients With Acute Ischemic Stroke

Jauch¹,

Saver²,

Adams³

et al. 2013

Stroke

5,370

1,801

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Background and Purpose-The authors present an overview of the current evidence and management recommendations for evaluation and treatment of adults with acute ischemic stroke. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators responsible for the care of acute ischemic stroke patients within the first 48 hours from stroke onset. These guidelines supersede the prior 2007 guidelines and 2009 updates. Methods-Members of the writing committee were appointed by the American Stroke Association Stroke Council's Scientific Statement Oversight Committee, representing various areas of medical expertise. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Panel members were assigned topics relevant to their areas of expertise, reviewed the stroke literature with emphasis on publications since the prior guidelines, and drafted recommendations in accordance with the American Heart Association Stroke Council's Level of Evidence grading algorithm. Results-The goal of these guidelines is to limit the morbidity and mortality associated with stroke. The guidelines support the overarching concept of stroke systems of care and detail aspects of stroke care from patient recognition; emergency medical services activation, transport, and triage; through the initial hours in the emergency department and stroke unit. The guideline discusses early stroke evaluation and general medical care, as well as ischemic stroke, specific interventions such as reperfusion strategies, and general physiological optimization for cerebral resuscitation. The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest. Guidelines for the Early Management of PatientsThis statement was approved by the American Heart Association Science Advisory and Coordinating Committee on December 12, 2012. A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By Topic" link or the "By Publication Date" link. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@wolterskluwer.com.The Executive Summary is available as an online-only Data Supplement with this article at http://stroke.ahajournals.org/lookup/suppl/ doi:10.1161/STR.0b013e318284056a/-/DC1.The American Heart Association requests that this document be cited as follows: Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ, Demaerschalk BM, Khatri P, McMullan PW Jr, Qureshi AI, Rosenfield K, Scott PA, Summers DR, Wang DZ, Wintermark M, Yonas H; on behalf of the American Heart Association Stroke Council, Council on Cardio...

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Section: March 2013mentioning

confidence: 99%

Guidelines for the Early Management of Patients With Acute Ischemic Stroke

Jauch¹,

Saver²,

Adams³

et al. 2013

Stroke

5,370

1,801

View full text Add to dashboard Cite

show abstract

“…13 The Registry started in 1988 and at the time of this study had data on 1843 patients. We explored the Registry and compared the prevalence of first-ever territorial cerebral infarcts and cardio-embolic stroke in both hemispheres.…”

Section: Study 2: Stroke Registrymentioning

confidence: 99%

“…In addition, we looked at side differences for small deep lacunar infarcts, because this type of infarct would not be expected to occur more frequently on one side. Definitions to classify stroke subtypes have been described before 13 and are based on the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. 17 Analyses were performed for the whole group of patients with first-ever stroke as well as for the subgroup of patients who were known to be hypertensive.…”

Section: Study 2: Stroke Registrymentioning

confidence: 99%

“…For the current analysis, we selected 102 untreated hypertensive patients in whom no known cause for their hypertension could be detected, who did not have any symptoms suggestive of cerebrovascular disease or prior stroke and who otherwise were also free of apparent cardiovascular complications. This specific population was chosen because hypertension is a major determinant of IMT and stroke 13,14 and because the absence of cardiovascular complications would render secondary changes of IMT less likely. Blood pressure was measured before each IMT measurement after 5 minutes of rest in sitting position.…”

Section: Study 1: Imt Measurementsmentioning

confidence: 99%

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Is There a Side Predilection for Cerebrovascular Disease?

et al. 2003

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Abstract-In studies on carotid artery intima-media thickness and stroke, researchers implicitly assume that cerebrovascular abnormalities show a symmetrical distribution. To evaluate whether there is a difference in intima-media thickness between the 2 carotids, we compared left and right common carotid artery intima-media thickness as measured by B-mode ultrasonography in a group of 102 untreated hypertensive patients. This yielded a significant difference between both sides (left, 0.75Ϯ0.11 mm; right, 0.71Ϯ0.11 mm; PϽ0.001). This was associated with a higher cross-sectional area of the intima-media complex and a higher flow velocity at the left side. Arterial diameters, however, were not different. We also assessed whether there is a side preference with respect to cerebrovascular accidents. To this end, we explored our population-based Stroke Registry of 1843 subjects and indeed found a significantly higher incidence of nonlacunar cerebrovascular stroke at the left side, whereas lacunar infarcts were symmetrically distributed. Our findings suggest a predilection for cerebrovascular disease at the left side, which may be related to greater hemodynamic stress and intimal damage in the left carotid artery. Key Words: carotid arteries Ⅲ atherosclerosis Ⅲ cerebral arteries Ⅲ stroke A n increase in carotid artery intima-media thickness (IMT) not only coincides with other risk factors such as hypercholesterolemia, hypertension, and diabetes mellitus but also correlates independently with clinical end points such as myocardial infarction and peripheral atherosclerosis. [1][2][3][4][5][6][7] Recent data have confirmed the relationship between IMT and stroke, especially of the nonlacunar subtype. 8 Thus, an increase in IMT can be considered as a marker of cardiovascular risk. Usually, one averages measurements from the left and right common carotid artery for the determination of IMT. 9 However, it is not known whether this is justified, as differences may exist in IMT between both arteries. Indeed, during routine assessment, we frequently noted a left-right difference in IMT. Other studies also suggest differences between left and right IMT, 5,9 but it is not clear whether there is a systematic increase in favor of one side. This prompted us to systematically compare left and right IMT in a group of hypertensive patients who had been referred to our hospital for evaluation of their elevated blood pressure. Although an increased IMT of the internal carotid artery correlates well with the risk of both myocardial infarction and stroke, a higher IMT of the common carotid artery (CCA) is a good predictor of stroke incidence as well as prevalent stroke. 10,11 Moreover, Cupini and coworkers 8 demonstrated that CCA IMT values are higher in patients with nonlacunar stroke than in those with lacunar stroke, thereby lending further support to the notion that an increased IMT is a marker of atherosclerotic (ie, nonlacunar) cerebrovascular complications rather than of microvascular (lacunar) lesions. For these reasons and because ...

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“…The ‘window’ size of 100 is considered to give robust estimates of probability of outcome of interest in that central interval of baseline BP from about 200 patients with and without thrombolysis. Boreas et al [16] have used a similar method to explore the cut-off point of BP, though baseline BP could not be identified as independent predictors of stroke outcome [16]. …”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcome as Function of Blood Pressure in Acute Ischemic Stroke and Effects of Thrombolysis

et al. 2007

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Background: While baseline blood pressure (BP) is a known predictor of 90-day residual deficit after acute ischemic stroke, the effect of thrombolysis on this relationship has not been described. To study the interaction and to find intervals of prognostic significance, the functional forms of this predictive relationship should be found and compared for recombinant tissue plasminogen activator (rt-PA)- and placebo-treated patients of the first European Cooperative Acute Stroke Study. Methods: We studied the 615 patients with acute ischemic hemispheric stroke randomized and treated in the first European Cooperative Acute Stroke Study. Endpoints were fatal outcome within and favorable outcome (no or negligible long-term handicap on the modified Rankin Scale scores 0 or 1) after 90 ± 14 days. Functional relationships with baseline BP were estimated fully nonparametrically as moving averages of occurrences of either outcome among placebo- and rt-PA-treated patients, separately. Visual findings were corroborated by conventionally stratified logistic regression. Results: For favorable outcome, an S-shaped functional relationship with baseline systolic BP (SBP) was found with an averaged incremental rate around 10% per 1 mm Hg increase in baseline SBP between 140 and 160 mm Hg, among rt-PA and placebo patients. Similar results were obtained for diastolic BP (DBP) between 80 and 90 mm Hg. Odds ratios in favor of rt-PA were 1.96 (95% CI: 1.02–3.78) and 2.87 (95% CI: 1.36–6.04) for SBP and DBP in these intervals, respectively. For mortality, visible markedly lower risks in the placebo group between 120 and 140 and between 160 and 180 mm Hg SBP were confirmed with adjusted OR of 2.47 (95% CI: 1.09–5.64) and 9.73 (95% CI: 2.02–46.82), respectively. Conclusions: Patients benefited from rt-PA in terms of no or negligible handicap after 90 days, without excess risk of death, with baseline SBP between 140 and 160 mm Hg or baseline DBP between 80 and 90 mm Hg.

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Prognostic value of blood pressure in acute stroke

Cited by 41 publications

References 31 publications

Guidelines for the Early Management of Patients With Acute Ischemic Stroke

Guidelines for the Early Management of Patients With Acute Ischemic Stroke

Is There a Side Predilection for Cerebrovascular Disease?

Long-Term Outcome as Function of Blood Pressure in Acute Ischemic Stroke and Effects of Thrombolysis

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