Relationship between Blood Pressure and Outcomes in Acute Ischemic Stroke Patients Administered Lytic Medication in the TIMS-China Study

Background: Variability in blood pressure is a predictor of stroke severity and causes of poor functional outcome. Blood pressure variability is one of the main predictor of the prognosis acute ischemic stroke. Blood pressure variability were independently and linearly associated with the development of early neurologic deterioration (END) in acute ischemic stroke Objective: To determine the association between blood pressure variability and END in acute ischemic stroke patients. Method: This study uses a cross sectional design. Sampling was conducted at H. Adam Malik General Hospital Medan. Samples were taken as many as 40 subjects consecutively. Blood pressure checks were perform every hour for 72 hours then an assessment of the National Institute of Health Stroke Scale (NIHSS) score at admission and the third day of treatment. Data analysis used fisher’s exact test. Results: The demographic characteristics of the study subjects were an average age of 56-<71 years, high school education level, housewife occupation and Batak ethnicity. The mean of maximum systolic blood pressure (SBP) was 151±12.16 mmHg, minimum SBP 123.15±18 mmHg, delta SBP 25.35±10.66 mmHg, maximum diastolic blood pressure (DBP) 79.7±6.01 mmHg, minimum DBP 61.77±7.32 mmHg and delta DBP 17.97±8.48 mmHg. The NIHSS day 1 score had an average of 9.55±6.73, the NIHSS day 3 score was 11.25±7.93. Most subjects experienced END. There is a significant relationship between blood pressure variability and END with a p of 0.03 (p<0.05). Conclusion: There is a significant relationship between blood pressure variability and END in patients with acute ischemic stroke.

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Blood pressure excursions in acute ischemic stroke patients treated with intravenous thrombolysis

Journal of Hypertension ◽

10.1097/hjh.0000000000002628 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Georgios Tsivgoulis ◽

Aristeidis H. Katsanos ◽

Pitchaiah Mandava ◽

Martin Köhrmann ◽

Lauri Soinne ◽

...

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Intravenous Thrombolysis ◽

Stroke Patients

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Rationale and design of a randomized trial of early intensive blood pressure lowering on cerebral perfusion parameters in thrombolysed acute ischemic stroke patients

Medicine ◽

10.1097/md.0000000000012721 ◽

2018 ◽

Vol 97 (40) ◽

pp. e12721 ◽

Cited By ~ 1

Author(s):

Vijay K. Sharma ◽

Benjamin Y.Q. Tan ◽

M. Ying Sim ◽

Amit Kulkarni ◽

Philip A. Seow ◽

...

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Randomized Trial ◽

Acute Ischemic Stroke ◽

Cerebral Perfusion ◽

Blood Pressure Lowering ◽

Stroke Patients ◽

Pressure Lowering ◽

Intensive Blood Pressure

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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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Effect of blood pressure on early neurological deterioration of acute ischemic stroke patients with intravenous rt-PA thrombolysis may be mediated through oxidative stress induced blood-brain barrier disruption and AQP4 upregulation

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2020.104997 ◽

2020 ◽

Vol 29 (8) ◽

pp. 104997

Author(s):

Yan He ◽

Qin Yang ◽

Hua Liu ◽

Ling Jiang ◽

Qin Liu ◽

...

Keyword(s):

Oxidative Stress ◽

Blood Pressure ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Blood Brain Barrier ◽

Stroke Patients ◽

Barrier Disruption ◽

Blood Brain Barrier Disruption ◽

Early Neurological Deterioration ◽

Brain Barrier Disruption

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Abstract WP94: Higher Mortality in Slow Blood Pressure Droppers: Blood Pressure Trajectory Groups of 1-Year After Acute Ischemic Stroke

Stroke ◽

10.1161/str.51.suppl_1.wp94 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Keon-Joo Lee ◽

Beom Joon Kim ◽

Moon-Ku Han ◽

Joon-Tae Kim ◽

Kang Ho Choi ◽

...

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Symptom Onset ◽

Time Course ◽

Information Criterion ◽

Stroke Recurrence ◽

Stroke Patients ◽

Composite Events

Introduction: Although the effect of blood pressure in post-stroke outcome is well recognized, the long-term time course of BP following acute ischemic stroke and it’s influence to outcomes have not been well elucidated. Method: From a multicenter prospective registry of acute ischemic stroke patients, a total of 5,514 patients with measurement of systolic blood pressure (SBP) in more than 2 of 7 prespecified time points up to 1 year after symptom onset were analyzed. The patients were grouped according to longitudinal SBPs of each patient using a group-based trajectory model, and number of groups were determined by the optimal delta-Bayesian Information Criterion. Outcome measures, which were stroke recurrence, mortality and composite of each events along with myocardial infarction were prospectively collected up to 1 year after symptom onset. Results: Patients were categorized into four groups according to their SBP trajectories: low (27.0%), moderate (59.5%), persistently high (1.2%), and slowly dropping (12.4%). After adjustment for pre-determined covariates, there were higher risk of stroke recurrence in persistently high SBP group (hazard ratio (HR), 2.28 [95% confidence interval (CI), 1.01-5.12]). Mortality was higher only in the slowly dropping SBP group (HR, 1.50 [95% CI, 1.09-2.05]). Composite events were higher in both persistently high (HR, 1.96 [95% CI, 1.02-3.75]) and slowing dropping (HR, 1.54 [95% CI, 1.18-2.00]) SBP groups. Conclusion: There were a group of patterns in long-term longitudinal SBP changes after acute ischemic stroke. Especially, slow BP droppers might have a distinct nature with higher mortality and would be a target for future investigations.

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