Relationship between outcome and baseline blood pressure and other haemodynamic measures in acute ischaemic stroke: data from the TAIST trial

Sprigg, Nikola; Gray, Laura J.; Bath, Philip M.W.; Boysen, Gudrun; Deyn, Peter Paul De; Friis, Pål; Leys, Didier; Marttila, Reijo J.; Olsson, Jan‐Edvin; Neill, Desmond O; Ringelstein, Bernd; Sande, J.J. van der; Lindenstrøm, E

doi:10.1097/01.hjh.0000234123.55895.12

Cited by 89 publications

(73 citation statements)

References 21 publications

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“…Central BP (rather than peripheral brachial BP) is more relevant to the cerebral circulation and amphetamine increased this. RPP (the mathematical product of HR and systolic BP, 44 an index of myocardial work and associated with a poor outcome after stroke 34 ) was similarly increased with amphetamine. In parallel, the BUI (an estimate of myocardial perfusion) was decreased nonsignificantly after amphetamine.…”

Section: Discussionmentioning

confidence: 96%

“…Pulse pressure (PP ¼ SBPÀDBP) and rate-pressure product (RPP ¼ HR Â SBP) were calculated from measured parameters. 37 Central BP, mean arterial pressure (MAP), compliance (augmentation index (AI)) and myocardial perfusion (Buckberg index (BUI) 38 ) were assessed by applanation tonometry pulse wave analysis (SphygmoCor Px, Australia) at the radial artery. Cardiac output and peripheral vascular resistance were measured by Portapres (NO-TPD Biomedical Instrumentation, Amsterdam, Netherlands).…”

Section: Haemodynamic Measuresmentioning

confidence: 99%

“…32 Furthermore, no data exist on the effect of amphetamine on central or cerebral haemodynamic in this population, despite recent evidence that these parameters can be related to outcome in acute stroke. 33,34 We performed a phase II trial assessing the effect of amphetamine on motor function, and cerebral and cardiac haemodynamics. We hypothesized that amphetamine would improve recovery from stroke when given with physiotherapy, and sympathomimetic actions would increase BP and HR, and alter cardiac haemodynamics and cerebral blood flow velocity.…”

Section: Introductionmentioning

confidence: 99%

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Amphetamine increases blood pressure and heart rate but has no effect on motor recovery or cerebral haemodynamics in ischaemic stroke: a randomized controlled trial (ISRCTN 36285333)

et al. 2007

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Amphetamine enhances recovery after experimental ischaemia and has shown promise in small clinical trials when combined with motor or sensory stimulation. Amphetamine, a sympathomimetic, might have haemodynamic effects in stroke patients, although limited data have been published. Subjects were recruited 3-30 days post-ischaemic stroke into a phase II randomized (1:1), double-blind, placebo-controlled trial. Subjects received dexamphetamine (5 mg initially, then 10 mg for 10 subsequent doses with 3-or 4-day separations) or placebo in addition to inpatient physiotherapy. Recovery was assessed by motor scales (Fugl-Meyer (FM)), and functional scales (Barthel index (BI) and modified Rankin score (mRS)). Peripheral blood pressure (BP), central haemodynamics and middle cerebral artery blood flow velocity were assessed before, and 90 min after, the first two doses. Thirty-three subjects were recruited, aged 33-88 (mean 71) years, males 52%, 4-30 (median 15) days post stroke to inclusion. Sixteen patients were randomized to placebo and seventeen to amphetamine. Amphetamine did not improve motor function at 90 days; mean (s.d.) FM 37.6 (27.6) vs control 35.2 (27.8) (P ¼ 0.81). Functional outcome (BI, mRS) did not differ between treatment groups. Peripheral and central systolic BP, and heart rate (HR), were 11.2 mm Hg (P ¼ 0.03), 9.5 mm Hg (P ¼ 0.04) and 7 beats per minute (P ¼ 0.02) higher, respectively, with amphetamine, compared with control. A nonsignificant reduction in myocardial perfusion (BUI) was seen with amphetamine. Other cardiac and cerebral haemodynamics were unaffected. Amphetamine did not improve motor impairment or function after ischaemic stroke but did significantly increase BP and HR without altering cerebral haemodynamics.

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Section: Discussionmentioning

confidence: 96%

Section: Haemodynamic Measuresmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Amphetamine increases blood pressure and heart rate but has no effect on motor recovery or cerebral haemodynamics in ischaemic stroke: a randomized controlled trial (ISRCTN 36285333)

et al. 2007

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“…The effects of blood pressure at admission on the prognosis of patients with acute ischemic stroke are complex and controversy. Both high and low SBP were independently associated with increased early death and late death or dependency (Leonardi‐Bee et al., 2002; Sprigg et al., 2006). The clinical meaning of the findings is not clear and worthy of attention.…”

Section: Discussionmentioning

confidence: 99%

Dehydration is a strong predictor of long‐term prognosis of thrombolysed patients with acute ischemic stroke

Yin

Zhou

et al. 2017

Brain and Behavior

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Background and PurposeDehydration was found to be involved in the poor prognosis of patients with acute ischemic stroke. It is unclear whether dehydration status before onset is related with prognosis of thrombolysed patients with acute ischemic stroke. If it is the case, quickly hydrating may improve the prognosis. The present study was designed to explore the issue.MethodsEligible 294 patients with acute ischemic stroke after thrombolysis were enrolled in the present study according to inclusion/exclusion criteria. According to the modified Rankin scale (mRS) 90 days post stroke, the patients were divided into two groups: mRS 0–2 (n = 191) and mRS 3–6 (n = 103). In the present study, BUN/Cr ≥ 15 combined with USG > 1.010 or either of them were chosen as dehydration marker. Clinical data were analyzed between two groups. Univariate and multivariate statistical analyses were carried out.ResultsAge, fibrinogen, blood glucose, BUN/Cr, NIHSS score at admission, the systolic blood pressure (SBP) before thrombolysis, dehydration status (BUN/Cr ≥ 15 plus USG > 1.010), hyperlipidemia, USG and D‐dimer on admission day, and TOAST classification showed significant difference between two groups (p < .05). Further stratification analysis showed that BUN/Cr ≥ 15, NIHSS ≥ 6, blood glucose ≥8, and SBP > 150 were markedly associated with poor outcome (mRS 3–6, p < .05). After adjusting for age, fibrinogen, USG, D‐dimer, dehydration status, NIHSS, blood glucose, SBP, hyperlipidemia, and BUN/Cr at admission, multivariate logistic regression showed that dehydration status, higher NIHSS, higher blood glucose, and higher SBP at admission were independent risk factors for predicting the long‐term poor prognosis of thrombolysed patients.ConclusionsThe present findings suggest that BUN/Cr ≥ 15 combined with USG > 1.010 as a marker of dehydration status was an independent risk factor for long‐term poor prognosis of thrombolysed patients with acute ischemic stroke.

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“…The answers to what would be the optimal values of blood pressure and what would be the indications and best forms of control during this period remain controversial. The tendency is to avoid aggressive interventions in acute stroke [76][77][78][79][80] . Hypotension is rare in acute stroke patients and is usually associated with acute myocardial infarction, congestive heart failure, hypovolemia and sepsis.…”

Section: Stroke In the Emergency Departmentmentioning

confidence: 99%

Guidelines for acute ischemic stroke treatment: part I

Oliveira‐Filho

Martins

Pontes-Neto

et al. 2012

Arq. Neuro-Psiquiatr.

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These guidelines are a result of several meetings from the Brazilian Stroke Society (Sociedade Brasileira de Doenças Cerebrovasculares -SBDCV, website www.sbdcv.org.br), which represents the Scientific Department in cerebrovascular diseases of the Brazilian Academy of Neurology, responsible for technical opinions and educational projects related to cerebrovascular diseases. Members from SBDCV participated in web-based discussion forum with pre-defined themes, followed by a formal onsite meeting in which controversies and final position statements were discussed. Finally, a writing group was created to revise and translate the final document, which was approved by all members of the SBDCV. The final text aims to guide specialists and non-specialists in stroke care in managing patients with acute ischemic stroke. The hemorrhagic stroke guideline has been previously published by the same group 1 . In the final recommendations, Oxford classification for evidence level and recommendation grade was used: EVIDENCE LEVELS1. Randomized controlled clinical trial (RCT) or systematic review (SR) of RCT with clinical endpoints. 2. RCT or SR of lower quality: with substitute, validated endpoints; with subgroup analysis or with a posteriori hypotheses; with clinical endpoints, but with methodological flaws.3. RCT with substitute, non-validated endpoints case-control studies. 4. Study with clinical endpoint, but with a higher potential bias (as in experiment without comparison group and other observational studies). 5. Representative forum or expert opinion without abovementioned evidence. RECOMMENDATION GRADESA Systematic review (homogeneous) of RCT; or single RCT with narrow confidence interval; or therapeutic results of "all or nothing" type. B Systematic review (homogeneous) of cohort studies; or cohort study and RCT of lower quality; or outcomes research or ecological study; or systematic review (homogeneous) of case-control studies; or case-control study. C Case reports (including cohort or case-control study of lower quality). D Expert opinion without critical evaluation, based on physiological or animal studies.In this first part of the guidelines, specific topics included were: epidemiology, stroke as a medical emergency, education, pre-hospital management, emergency management, neuroimaging and laboratory evaluation. A translated version of these guidelines in Portuguese is available in the Society's webpage (www.sbdcv.org.br).

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Relationship between outcome and baseline blood pressure and other haemodynamic measures in acute ischaemic stroke: data from the TAIST trial

Abstract: A poor outcome is independently associated with elevations in blood pressure, HR and their derived haemodynamic variables, including PP and the RPP. Agents that modify these measures may improve functional outcome after stroke.

Cited by 89 publications

References 21 publications

Amphetamine increases blood pressure and heart rate but has no effect on motor recovery or cerebral haemodynamics in ischaemic stroke: a randomized controlled trial (ISRCTN 36285333)

Amphetamine increases blood pressure and heart rate but has no effect on motor recovery or cerebral haemodynamics in ischaemic stroke: a randomized controlled trial (ISRCTN 36285333)

Dehydration is a strong predictor of long‐term prognosis of thrombolysed patients with acute ischemic stroke

Guidelines for acute ischemic stroke treatment: part I

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