Impact of Early Blood Pressure Lowering in Patients Presenting with Acute Ischemic Stroke

Abstract Purpose of Review In this review article we will discuss the acute hypertensive response in the context of acute ischemic stroke and present the latest evidence-based concepts of the significance and management of the hemodynamic response in acute ischemic stroke. Recent Findings Acute hypertensive response is considered a common hemodynamic physiologic response in the early setting of an acute ischemic stroke. The significance of the acute hypertensive response is not entirely well understood. However, in certain types of acute ischemic strokes, the systemic elevation of the blood pressure helps to maintain the collateral blood flow in the penumbral ischemic tissue. The magnitude of the elevation of the systemic blood pressure that contributes to the maintenance of the collateral flow is not well established. The overcorrection of this physiologic hemodynamic response before an effective vessel recanalization takes place can carry a negative impact in the final clinical outcome. The significance of the persistence of the acute hypertensive response after an effective vessel recanalization is poorly understood, and it may negatively affect the final outcome due to reperfusion injury. Summary Acute hypertensive response is considered a common hemodynamic reaction of the cardiovascular system in the context of an acute ischemic stroke. The reaction is particularly common in acute brain embolic occlusion of large intracranial vessels. Its early management before, during, and immediately after arterial reperfusion has a repercussion in the final fate of the ischemic tissue and the clinical outcome.

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Impact of blood pressure levels within first 24 hours after mechanical thrombectomy on clinical outcome in acute ischemic stroke patients

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014548 ◽

2019 ◽

Vol 11 (8) ◽

pp. 735-739 ◽

Cited By ~ 10

Author(s):

David Cernik ◽

Daniel Sanak ◽

Petra Divisova ◽

Martin Kocher ◽

Filip Cihlar ◽

...

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Clinical Outcome ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Mechanical Thrombectomy ◽

Positive Impact ◽

Multivariate Regression Analysis ◽

Early Management ◽

Symptomatic Intracerebral Hemorrhage

IntroductionDespite early management and technical success of mechanical thrombectomy (MT) for acute ischemic stroke (AIS), not all patients reach a good clinical outcome. Different factors may have an impact and we aimed to evaluate blood pressure (BP) levels in the first 24 hours after MT.MethodsConsecutive AIS patients treated with MT were enrolled in the retrospective bi-center study. Neurological deficit was assessed with National Institutes of Health Stroke Scale (NIHSS) and functional outcome after 3 months with modified Rankin scale (mRS) with a score 0–2 for good outcome. The presence of symptomatic intracerebral hemorrhage (SICH) was assessed according to the SITS–MOST criteria.ResultsOf 703 treated patients, completed BP levels were collected in 690 patients (350 males, mean age 71±13 years) with median of admission NIHSS 17 points. Patients with mRS 0–2 had a lower median of systolic BP (SBP) compared with those with poor outcome (131 vs 140 mm Hg, P<0.0001). The rate of SICH did not differ between the patients with a median of SBP <140 mm Hg and ≥140 mm Hg. (5.1% vs 5.1%, P=0.980). Multivariate regression analysis with adjustment for potential confounders showed a median of distolic BP (P=0.024, OR: 0.977, 95% CI: 0.957 to 0.997) as a predictor of good functional outcome after MT, and a median of maximal SBP (P=0.038; OR: 0.990, 95% CI: 0.981 to 0.999) in the patients with achieved recanalization.ConclusionLowering of BP within the first 24 hours after MT may have a positive impact on clinical outcome in treated patients.

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Temporal profiles of blood pressure, circulating nitric oxide, and adrenomedullin as predictors of clinical outcome in acute ischemic stroke patients

Molecular Medicine Reports ◽

10.3892/mmr.2016.5001 ◽

2016 ◽

Vol 13 (5) ◽

pp. 3724-3734 ◽

Cited By ~ 18

Author(s):

MARTA SERRANO-PONZ ◽

CARMEN RODRIGO-GASQUÉ ◽

EVA SILES ◽

ESTHER MARTÍNEZ-LARA ◽

LAURA OCHOA-CALLEJERO ◽

...

Keyword(s):

Nitric Oxide ◽

Blood Pressure ◽

Ischemic Stroke ◽

Clinical Outcome ◽

Acute Ischemic Stroke ◽

Stroke Patients ◽

Temporal Profiles

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Blood Pressure and Clinical Outcome in Acute Ischemic Stroke

Stroke ◽

10.1161/01.str.0000037540.62580.cd ◽

2002 ◽

Vol 33 (11) ◽

pp. 2548-2548

Author(s):

Wolfgang Lalouschek ◽

Wilfried Lang

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Clinical Outcome ◽

Acute Ischemic Stroke

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E-085 Good Baseline Angiographic Collateral Flow Correlates with Successful Recanalization and Clinical Outcome after Endovascular Treatment for Acute Ischemic Stroke Within 24 Hours from Onset

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2016-012589.157 ◽

2016 ◽

Vol 8 (Suppl 1) ◽

pp. A87.1-A87

Author(s):

J Seo ◽

E Kim ◽

H Jeong

Keyword(s):

Ischemic Stroke ◽

Clinical Outcome ◽

Endovascular Treatment ◽

Acute Ischemic Stroke ◽

Collateral Flow

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The Relationship between Blood Pressure Variability, Recanalization Degree, and Clinical Outcome in Large Vessel Occlusive Stroke after an Intra-Arterial Thrombectomy

Cerebrovascular Diseases ◽

10.1159/000495300 ◽

2018 ◽

Vol 46 (5-6) ◽

pp. 279-286 ◽

Cited By ~ 8

Author(s):

Jun Young Chang ◽

Sang Beom Jeon ◽

Jung Hwa Lee ◽

O-Ki Kwon ◽

Moon-Ku Han

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Clinical Outcome ◽

Acute Ischemic Stroke ◽

Blood Pressure Variability ◽

Target Organ Damage ◽

Large Vessel ◽

Stroke Patients ◽

Short Term ◽

The Mean

Background: Blood pressure variability (BPV) is associated with target organ damage progression and increased cardiovascular events, including stroke. The aim of this study was to evaluate the associations between short-term BPV during acute periods and recanalization degree, early neurological deterioration (END) occurrence, and functional outcomes in acute ischemic stroke patients who had undergone intra-arterial thrombectomy (IAT). Methods: We retrospectively analyzed 303 patients with large vessel occlusive stroke who underwent IAT. The following BPV parameters, measured over 24 and 48 h after IAT, were compared: the mean, SD, coefficient of variation (CV), variation independent of the mean (VIM) for both the systolic BP (SBP) and diastolic BP, and the proportion of nocturnal SBP risers. Results: BPV parameters decreased with higher recanalization degree. The mean SBP (SBPmean) over 24 and 48 h after IAT, and the SD of SBP (SBPSD), CV of SBP (SBPCV), and VIM of SBP (SBPVIM) during the 48 h following the procedure had significant associations with recanalization degree. Patients with END had higher BPV than that of those without END, and the difference was more evident for incomplete recanalization. Increased BPV was associated with a shift toward poor functional outcome at 3 months after adjustment, including recanalization degree (OR range for significant parameters, 1.26–1.64, p = 0.006 for 48 h SBPmean, p = 0.003 for 48 h SBPCV, otherwise p < 0.002). Conclusions: Short-term BPV over 24 and 48 h after IAT in acute ischemic stroke patients was related to recanalization degree, and END occurrence, and may be an independent predictor of clinical outcome.

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Blood Pressure and Early Clinical Outcome Among Acute Ischemic Stroke Patients

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100011379 ◽

2011 ◽

Vol 38 (2) ◽

pp. 225-229 ◽

Cited By ~ 7

Author(s):

Jintao Zhang ◽

Ying Peng ◽

Huanqing Fan ◽

Mei Chen ◽

Tan Xu ◽

...

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Clinical Outcome ◽

Acute Ischemic Stroke ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Resonance Imaging ◽

Stroke Patients ◽

Short Term ◽

Tomography Scan

ABSTRACT:Objectives:The association between blood pressure (BP) and short-term clinical outcome of acute ischemic stroke is inconclusive. We investigated the association between BP in the first 72 hours following admission and death in-hospital and neurologic deficiency at discharge among patients with acute ischemic stroke.Methods:A total of 2675 acute ischemic stroke patients confirmed by a computed tomography scan or magnetic resonance imaging were included in the present study. Blood pressure in the first 72 hours after admission and other study variables were collected for all ischemic stroke patients. Neurological functions National Institute of Health Stroke Scale (NIHSS) were evaluated by trained neurologists at discharge. The study outcome was defined as death in-hospital and neurologic deficiency (NIHSS≥10) at discharge.Results:Systolic and diastolic BP were significantly and positively associated with odds of study outcome in acute ischemic stroke. For example, compared to those with a systolic BP<140 mmHg, multiple-adjusted odds ratio (95% confidence interval) of study outcome was 3.29(1.22, 8.90) among participants with systolic BP of 180-219 mmHg,P<0.05; compared to those with a diastolic BP<90 mmHg, multiple-adjusted odds ratio of study outcome was 7.05(1.32, 37.57) among participants with diastolic BP ≥ 120 mmHg,P<0.05.Conclusion:Systolic BP≥180 and diastolic BP≥120 were significantly and positively associated with death in-hospital or neurologic deficiency at discharge among patients with acute ischemic stroke.

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