Association between systolic blood pressure course and outcomes after stroke thrombectomy

BackgroundSystolic blood pressure (SBP) after endovascular thrombectomy (EVT) for large artery occlusive stroke is dynamic, requiring adaptable early prediction tools for improving outcomes. We investigated if post-EVT SBP course was associated with outcomes.MethodsEVT-treated patients who had a stroke at Karolinska University Hospital, Stockholm, Sweden, were included in the study during 12 February 2018–11 February 2020. SBP was recorded during the first 24 hours after EVT. Primary outcome was functional independence defined by a Modified Rankin Scale score of 0–2 at 3 months. Secondary outcomes were death by 3 months, symptomatic intracranial haemorrhage and any intracranial haemorrhage. Patients with favourable outcomes were used as a reference SBP course in mixed linear effects models and compared with SBP courses of patients with unfavourable outcomes using the empirical best linear unbiased predictor, measuring deviations from the reference SBP course using the random effects. We tested model predictive stability for SBP measurements of only 18, 12 or 6 hours after EVT.Results374 patients were registered, with mean age 71, median NIHSS score of 15, and 53.2% men. Deviating from a linear SBP course starting at 130 mm Hg and decreasing to 123 mm Hg at 24 hours after EVT was associated with lower chances of functional independence (adjusted OR 0.53, 95% CI 0.29 to 0.88, for reaching either 99 or 147 mm Hg at 24 hours after EVT). All SBP course models for the remaining outcomes did not show statistical significance. Functional independence models showed stable predictive values for all time periods.ConclusionDeviating from a linear SBP course was associated with lower chances of 3-month functional independence.

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Low profile REBOA device for increasing systolic blood pressure in hemodynamic instability: single-center 4-year experience of use of ER-REBOA

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-020-01586-9 ◽

2021 ◽

Author(s):

David T. McGreevy ◽

Mitra Sadeghi ◽

Kristofer F. Nilsson ◽

Tal M. Hörer

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Hemodynamic Instability ◽

Balloon Occlusion ◽

University Hospital ◽

Trauma Patients ◽

Single Center ◽

Hemorrhage Control ◽

Single Center Experience ◽

Low Profile

Abstract Background Hemodynamic instability due to torso hemorrhage can be managed with the assistance of resuscitative endovascular balloon occlusion of the aorta (REBOA). This is a report of a single-center experience using the ER-REBOA™ catheter for traumatic and non-traumatic cases as an adjunct to hemorrhage control and as part of the EndoVascular resuscitation and Trauma Management (EVTM) concept. The objective of this report is to describe the clinical usage, technical success, results, complications and outcomes of the ER-REBOA™ catheter at Örebro University hospital, a middle-sized university hospital in Europe. Methods Data concerning patients receiving the ER-REBOA™ catheter for any type of hemorrhagic shock and hemodynamic instability at Örebro University hospital in Sweden were collected prospectively from October 2015 to May 2020. Results A total of 24 patients received the ER-REBOA™ catheter (with the intention to use) for traumatic and non-traumatic hemodynamic control; it was used in 22 patients. REBOA was performed or supervised by vascular surgeons using 7–8 Fr sheaths with an anatomic landmark or ultrasound guidance. Systolic blood pressure (SBP) increased significantly from 50 mmHg (0–63) to 95 mmHg (70–121) post REBOA. In this cohort, distal embolization and balloon rupture due to atherosclerosis were reported in one patient and two patients developed renal failure. There were no cases of balloon migration. Overall 30-day survival was 59%, with 45% for trauma patients and 73% for non-traumatic patients. Responders to REBOA had a significantly lower rate of mortality at both 24 h and 30 days. Conclusions Our clinical data and experience show that the ER-REBOA™ catheter can be used for control of hemodynamic instability and to significantly increase SBP in both traumatic and non-traumatic cases, with relatively few complications. Responders to REBOA have a significantly lower rate of mortality.

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Systolic Blood Pressure and Outcomes in Stable Outpatients with Recent Symptomatic Artery Disease: A Population-Based Longitudinal Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18179348 ◽

2021 ◽

Vol 18 (17) ◽

pp. 9348

Author(s):

Juan F. Sánchez Muñoz-Torrero ◽

Guillermo Escudero-Sánchez ◽

Julián F. Calderón-García ◽

Sergio Rico-Martín ◽

Nicolás Roberto Robles ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Lower Risk ◽

Multivariable Analysis ◽

Large Artery ◽

Risk Of Mortality ◽

Cardiovascular Morbidity And Mortality ◽

Artery Disease ◽

Ischemic Events

Objectives: The most appropriate targets for systolic blood pressure (SBP) levels to reduce cardiovascular morbidity and mortality in patients with symptomatic artery disease remain controversial. We compared the rate of subsequent ischemic events or death according to mean SBP levels during follow-up. Design: Prospective cohort study. FRENA is an ongoing registry of stable outpatients with symptomatic coronary (CAD), cerebrovascular (CVD) or peripheral artery disease (PAD). Setting: 24 Spanish hospitals. Participants: 4789 stable outpatients with vascular disease. Results: As of June 2017, 4789 patients had been enrolled in different Spanish centres. Of these, 1722 (36%) had CAD, 1383 (29%) CVD and 1684 (35%) PAD. Over a mean follow-up of 18 months, 136 patients suffered subsequent myocardial infarction, 125 had ischemic stroke, 74 underwent limb amputation, and 260 died. On multivariable analysis, CVD patients with mean SBP levels 130–140 mm Hg had a lower risk of mortality than those with levels <130 mm Hg (hazard ratio (HR): 0.39; 95% CI: 0.20–0.77), as did those with levels >140 mm Hg (HR: 0.46; 95% CI: 0.26–0.84). PAD patients with mean SBP levels >140 mm Hg had a lower risk for subsequent ischemic events (HR: 0.57; 95% CI: 0.39–0.83) and those with levels 130–140 mm Hg (HR: 0.47; 95% CI: 0.29–0.78) or >140 mm Hg (HR: 0.32; 95% CI: 0.21–0.50) had a lower risk of mortality. We found no differences in patients with CAD. Conclusions: In this real-world cohort of symptomatic arterial disease patients, most of whom are not eligible for clinical trials, the risk of subsequent events and death varies according to the levels of SBP and the location of previous events. Especially among patients with large artery atherosclerosis, PAD or CVD, SBP <130 mm Hg may result in increased mortality. Due to potential factors in this issue, Prospective, well designed studies are warranted to confirm these observational data.

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Persistent Autoregulatory Disturbance after Angioplasty for Cerebral Vasospasm

Interventional Neuroradiology ◽

10.1177/159101990200800410 ◽

2002 ◽

Vol 8 (4) ◽

pp. 409-415 ◽

Cited By ~ 2

Author(s):

D.K. Song ◽

M.R. Harrigan ◽

J.P. Deveikis ◽

J.E. McGillicuddy

Keyword(s):

Blood Pressure ◽

Blood Flow ◽

Systolic Blood Pressure ◽

Cerebral Vasospasm ◽

Artery Aneurysm ◽

Response To Therapy ◽

Large Artery ◽

Xenon Ct ◽

Symptomatic Vasospasm ◽

Hyperdynamic Therapy

Hyperdynamic therapy, consisting of hypervolemia, haemodilution, and hypertension, is an established treatment for cerebral vasospasm following subarachnoid haemorrhage. Angioplasty has emerged as an additional, effective treatment for symptomatic vasospasm. Loss of autoregulation, however, can occur despite effective angioplasty, underscoring the need for treatment with hyperdynamic therapy in combination with angioplasty. A 43-year-old woman underwent endovascular coiling of a ruptured left posterior communicating artery aneurysm. The patient went on to develop symptomatic vasospasm and was treated with hyperdynamic therapy and angioplasty. Autoregulation was assessed with xenon CT cerebral blood flow (CBF) measurement. An initial CBF study was obtained when the patient received dopamine and dobutamine infusions to maintain systolic blood pressure at 160 mmHg. The vasopressor drips were then temporarily held for twenty minutes, allowing the patient's systolic blood pressure to drop to 140 mmHg, and a repeat CBF study was obtained. Several days after angioplasty, CBF decreased significantly when the patient was taken off vasopressors, indicating impaired autoregulation. Hyperdynamic therapy was continued, and another CBF study one week later showed a return of autoregulation and normalization of CBF without induced hypertension. Autoregulation is disturbed during vasospasm. Although angioplasty can improve large artery blood flow during vasospasm, hyperdynamic therapy is also needed to maintain cerebral perfusion, particularly in the face of impaired autoregulation. Quantitative CBF measurement permits the maintenance of optimal CBF and monitoring of response to therapy.

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Abstract WP305: Impact of Potential Systolic Blood Pressure Treatment Thresholds on Hematoma Growth in Acute Intracerebral Hemorrhage

Stroke ◽

10.1161/str.44.suppl_1.awp305 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

David Rodriguez-Luna ◽

Marta Rubiera ◽

Marian Muchada ◽

Pilar Coscojuela ◽

Marc Ribo ◽

...

Keyword(s):

Blood Pressure ◽

Intracerebral Hemorrhage ◽

Systolic Blood Pressure ◽

Statistical Significance ◽

Secondary Analysis ◽

Hematoma Enlargement ◽

Treatment Thresholds ◽

Hematoma Growth ◽

Acute Intracerebral Hemorrhage ◽

The Impact

Background: Although the current AHA guidelines recommend maintaining systolic blood pressure (SBP) below 180 mmHg in acute intracerebral hemorrhage (ICH), little is known about the relationships between different therapeutic target thresholds and hematoma growth (HG). Therefore, we aimed to investigate the impact of potential SBP treatment thresholds on HG in patients with acute ICH. Methods: This study was a secondary analysis of data prospectively collected during a previously reported study of the impact of blood pressure (BP) on HG in 106 patients with acute (<6 hours) supratentorial ICH. Patients underwent baseline and 24-hour computed tomography scans, and noninvasive BP monitoring at 15 minutes interval over first 24 hours. SBP loads were defined as the percentage of 24-hour SBP monitoring values exceeding 140, 150, 160, 170, 180, 190, and 200 mmHg. HG was defined as a relative enlargement greater than 33% or an absolute expansion more than 6 mL at 24 hours. Results: Patients who experienced HG (34%) presented higher SBP loads in all thresholds, reaching statistical significance in 170, 180, and 190 thresholds, but not in the others (Figure). Whilst SBP load thresholds were correlated neither with baseline nor 24-hour ICH volumes, highest (170 to 200) but not lowest (140 to 160) SBP load thresholds were significantly correlated with the amount of both relative and absolute hematoma enlargement at 24 hours (p<0.05). In multivariate analyses, both SBP 170-load (OR 1.034, 95% CI 1.001-1.070, p=0.048) and 180-load (OR 1.052, 95% CI 1.010-1.097, p=0.016) were independently related to HG. Conclusions: In patients with acute supratentorial ICH, those who experience HG present higher SBP load from 140 to 200 mmHg thresholds. More intensive SBP-lowering treatment than guidelines recommendations is needed, at least below 170 mmHg, in order to minimize the deleterious effect of higher SBP on HG.

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Walking, but Not Weight Lifting, Acutely Reduces Systolic Blood Pressure in Older, Sedentary Men and Women

Journal of Aging and Physical Activity ◽

10.1123/japa.3.2.163 ◽

1995 ◽

Vol 3 (2) ◽

pp. 163-177 ◽

Cited By ~ 1

Author(s):

W. Jack Rejeski ◽

Karen M. Neal ◽

Martine E. Wurst ◽

Peter H. Brubaker ◽

Walter H. Ettinger

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Daily Living ◽

Statistical Significance ◽

Ambulatory Monitoring ◽

Weight Lifting ◽

Osteoarthritis Of The Knee ◽

Acute Bout ◽

Monitoring Devices ◽

Laboratory Stressor

An elderly patient population was used to investigate whether an acute bout of aerobic exercise (AE) would reduce systolic blood pressure (SBP) to a greater extent than would a bout of weight lifting (WL). SBPs were studied in the context of a laboratory Stressor as well as during activities of daily living using ambulatory monitoring devices (AMBPs). Patients participated in a laboratory Stressor and were monitored via AMBP for 8 hr. SBPs were lower for up to 5 hr postexercise for the AE treatment only. In addition, in comparison to no-exercise control data, baseline SBP was lower for the AE group than the WL group prior to the Stressor. Subjects in the AE condition also tended to have lower SBP responses following exercise than patients in the WL group, although these differences did not reach a conventional level of statistical significance. These data provide evidence that single bouts of AE, but not WL, may lower SBP in elderly patients, even for those who have compromised function due to osteoarthritis of the knee.

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11C-hydroxy-ephedrine-PET/CT in the Diagnosis of Pheochromocytoma and Paraganglioma

Cancers ◽

10.3390/cancers11060847 ◽

2019 ◽

Vol 11 (6) ◽

pp. 847 ◽

Cited By ~ 1

Author(s):

Achyut Ram Vyakaranam ◽

Joakim Crona ◽

Olov Norlén ◽

Per Hellman ◽

Anders Sundin

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Standardized Uptake Value ◽

Adrenal Incidentalomas ◽

Predictive Values ◽

Catecholamine Excess ◽

Clinical Scenarios ◽

Pet Ct ◽

Sensitivity Specificity

Pheochromocytomas (PCC) and paragangliomas (PGL) may be difficult to diagnose because of vague and uncharacteristic symptoms and equivocal biochemical and radiological findings. This was a retrospective cohort study in 102 patients undergoing 11C-hydroxy-ephedrine (11C-HED)-PET/CT because of symptoms and/or biochemistry suspicious for PCC/PGL and/or with radiologically equivocal adrenal incidentalomas. Correlations utilized CT/MRI, clinical, biochemical, surgical, histopathological and follow-up data. 11C-HED-PET/CT correctly identified 19 patients with PCC and six with PGL, missed one PCC, attained one false positive result (nodular hyperplasia) and correctly excluded PCC/PGL in 75 patients. Sensitivity, specificity, positive and negative predictive values of 11C-HED-PET/CT for PCC/PGL diagnosis was 96%, 99%, 96% and 99%, respectively. In 41 patients who underwent surgical resection and for whom correlation to histopathology was available, the corresponding figures were 96%, 93%, 96% and 93%, respectively. Tumor 11C-HED-uptake measurements (standardized uptake value, tumor-to-normal-adrenal ratio) were unrelated to symptoms of catecholamine excess (p > 0.05) and to systolic blood pressure (p > 0.05). In PCC/PGL patients, norepinephrine and systolic blood pressure increased in parallel (R2 = 0.22, p = 0.016). 11C-HED-PET/CT was found to be an accurate tool to diagnose and rule out PCC/PGL in complex clinical scenarios and for the characterization of equivocal adrenal incidentalomas. PET measurements of tumor 11C-HED uptake were not helpful for tumor characterization.

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Effect of Magnesium L-Lactate on Blood Pressure in Patients with an Implantable Cardioverter Defibrillator

Annals of Pharmacotherapy ◽

10.1345/aph.1l640 ◽

2009 ◽

Vol 43 (4) ◽

pp. 559-576 ◽

Cited By ~ 6

Author(s):

William L Baker ◽

Jeffrey Kluger ◽

C Michael White ◽

Krista M Dale ◽

Burton B Silver ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Magnesium Deficiency ◽

Statistical Significance ◽

Serum Magnesium ◽

Blood Pressure Reduction ◽

Intracellular Magnesium ◽

Time Period ◽

The Impact ◽

Oral Magnesium

Background: Previous studies have evaluated the impact of oral magnesium on blood pressure; however, they used magnesium salts with low bioavailability, had methodological issues, and showed differing results. Objective: To evaluate the long-term blood pressure–lowering ability of oral magnesium L-lactate versus placebo in patients with implanted cardioverter defibrillators (ICDs). Methods: In this double-blind, 24-week trial, 50 patients with ICDs were randomized to receive magnesium L-lactate (6 tablets daily, supplying a total of 504 mg of elemental magnesium daily) or matching placebo for at least 12 weeks. Baseline intracellular and serum magnesium concentrations were determined. The primary efficacy endpoint was the mean sitting systolic blood pressure at 24 weeks. Results: In 50 patients who completed at least 12 weeks of follow-up, 86% of patients, regardless of randomization, had a baseline intracellular magnesium deficiency, but no patients had a serum magnesium deficiency. At 12 weeks, magnesium L-lactate significantly reduced systolic blood pressure compared with placebo (117.7 ± 11.8 vs 126.3 ± 16.7 mm Hg, respectively; p = 0.04). In the 45 patients who continued in the study through the 24-week time period, the systolic blood pressure reduction was maintained, but statistical significance was lost (118.1 ± 14.1 vs 125.5 ± 17.2 mm Hg, respectively; p = 0.13). Magnesium L-lactate did not impact diastolic blood pressure at either time period (p ≥ 0.75 for both). Patients with a documented history of hypertension at baseline showed similar qualitative results to the primary analysis. Conclusions: A large number of subjects with ICDs have an intracellular magnesium deficiency not captured through serum magnesium determination. The use of magnesium L-lactate in patients with an ICD results in significant improvement in systolic blood pressure at 12 weeks, which may be maintained through 24 weeks.

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ESSENTIAL HYPERTENSION

The Professional Medical Journal ◽

10.29309/tpmj/2018.25.06.270 ◽

2018 ◽

Vol 25 (06) ◽

pp. 854-859

Author(s):

Imran Khan ◽

Abdul Ghaffar Dars ◽

Nisar Ahmed Shah ◽

Syed Zulfiquar Ali Shah

Keyword(s):

Blood Pressure ◽

Essential Hypertension ◽

Systolic Blood Pressure ◽

Postpartum Hemorrhage ◽

Female Gender ◽

University Hospital ◽

Cross Sectional ◽

Male And Female ◽

Treatment Status ◽

The Mean

Objectives: To determine the frequency of microalbuminuria in patients withessential hypertension for postpartum hemorrhage. Study Design: Cross sectional study.Setting: Department of Medicine at Liaquat University Hospital Hyderabad. Period: Six months(from January 2015 to June 2015). Patients and Methods: All the patients ≥35 years of age bothgender had essential hypertension were enrolled and explored for microalbuminuria by urineexamination while the data was analyzed in SPSS 16. Results: Total one hundred subjects withessential hypertension were studied and explored for microalbuminuria. The mean age ±SDof for overall population was 52.82±7.85 and it was 51.23±8.21 and 53.32±6.52 in male andfemale gender respectively. The overall mean ± SD for systolic blood pressure was 170±12.62whereas it was 160.82±10.82 and 165±11.92 in male and female gender respectively. Themean ±SD for blood pressure (diastolic) was 105±71 while it was 95.01±7.21 and 100.82±6.42in male and female sex respectively. The duration of hypertension as mean ±SD was 3.72±2.52in overall population. The microalbuminuria was identified in 59 (59%) patients with statisticalsignificance in relation to age (p=0.00), gender (p=0.00), duration of hypertension (p=0.01),treatment status (p= 0.04), hypertension (p=0.002), BMI (p=0.05) and residence (p=0.00).Conclusion: In present series the prevalence for microalbuminuria in essential hypertensionwas detected as 59% and correlate with age, gender and duration and treatment status of thepatients along with raised systolic and diastolic blood pressure

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Prognostic association between TOAST and functional dependence 90 days after ischemic stroke

10.5327/1516-3180.558 ◽

2021 ◽

Author(s):

Catarina Secundino Tavares de Araújo ◽

João Paste Silva ◽

Tiago Timotio de Almeida

Keyword(s):

Ischemic Stroke ◽

Functional Outcome ◽

Functional Dependence ◽

Statistical Significance ◽

Cryptogenic Stroke ◽

Functional Independence ◽

Large Artery ◽

Vessel Occlusion ◽

Correct Treatment ◽

Cross Sectional

Introduction: The etiologic classification of ischemic stroke according to TOAST is fundamental in stablishing the correct treatment to patients in order to prevent recurring strokes, besides helping to determine their prognosis. Objectives: To determine the relationship between TOAST and functional outcome 90 days after ischemic stroke, using the modified Rankin scale (mRS). Design and Setting: It’s a cross-sectional study with patients from HGRS – Salvador, Bahia. Methods: We classified all patients according to TOAST and stratified the mRS post-90 days in “functional independence” (mRs 0-2) and “functional dependence/death” (mRs 3-6). We included patients > 18 years old, admitted up to 72 hours from ictus, excluding those previously dependent (mRs ≥ 3). We used central tendency measures, chi- squared test and relative risk (RR). We considered IC = 95% and p <0,05 for statistical significance. Results: We included 268 patients. 59 had large-artery atherosclerosis (LAA), 39 small- vessel occlusion (SVO), 74 cardio embolism (CE) and 84 cryptogenic stroke (CS). There was no difference in gravity in admission between the groups nor in functional outcome in 90 days when the etiologies were grouped (p=0,07). Using CS as reference, CE had RR=1,34, LAA RR=1,31, SVO RR=0,99 for functional dependence (mRS ≥ 3) in 90 days. Conclusions: The RR analysis numerically shows that CE and LAA elevated the risk of functional dependence in 90 days in 30%. Bigger studies are required to sensitize the analysis.

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Abstract TMP7: Blood Pressure Goal Post Mechanical Yhrombectomy for Anterior and Posterior Circulation Stroke: A Multicenter Registry Study

Stroke ◽

10.1161/str.51.suppl_1.tmp7 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Ming Yang ◽

Xiaochuan Huo ◽

Ning Ma ◽

Feng Gao ◽

Dapeng Mo ◽

...

Keyword(s):

Blood Pressure ◽

Clinical Outcomes ◽

Functional Independence ◽

Artery Occlusion ◽

Posterior Circulation ◽

Blood Pressure Goal ◽

Large Artery ◽

Registry Study ◽

Anterior Circulation ◽

Posterior Circulation Stroke

Background and Purpose: The effect of blood pressure (BP) within 24 hours post-mechanical thrombectomy (MT) accounts on clinical outcomes for patients with successful reperfusion. We aimed to investigate the relationship between BP during 24 hours post-MT with clinical outcomes individually for anterior circulation stroke (ACS) or posterior circulation stroke (PCS) patients Method: Patients with successful recanalization and a full record of systolic BP (SBP) and diastolic BP (DBP) every two hours within 24 hours post-MT were included from the ANGEL study, a multi-centric, prospective registry study of endovascular treatment owing to proximal large-artery occlusion from June 2015 to December 2017. We divided patients into three groups based on maximum SBP: <140 (intensive), 140-160 (moderate) and <180 mmHg (permissive). Clinical outcomes included functional independence (modified Rankin Scale score 0-2), mortality at 90 days follow up and intracerebral hemorrhage (ICH). Results: 355 eligible patients were enrolled in this study. There were 162, 124, and 69 patients in the intensive, moderate, and permissive group, respectively. A 10mmHg increase of maximum SBP during the first 24 hours post-MT was independently associated with a lower likelihood of functional independence (OR=0.84 [0.75-0.94], p=0.001) at 90 days after adjusting for potential confounders. As to ACS, intensive SBP management was associated with higher odds of 90-day functional independence (OR=0.38 [0.18-0.79], p=0.010), compared with permissive SBP group. As to PCS, moderate SBP management was associated with lower odds of 90-day mortality, either compared with permissive or intensive SBP group. Conclusion: Higher maximum SBP post-MT was independently associated with a higher risk of poor clinical outcomes. Intensive SBP control may be more reasonable for patients with ACS, while moderate SBP is more beneficial for PCS. Although more randomized trials are needed.

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