Purpose-To estimate the prevalence of elevated blood pressure in adult patients with acute stroke in the United States (U.S.).Methods-Stroke patients were classified by initial systolic blood pressure into four categories using demographic, clinical, and treatment data from the National Hospital Ambulatory Medical Care Survey, the largest study of utilization and provision of emergency department services in the U.S. We also compared the age-, sex-, and ethnicity-adjusted rates of elevated blood pressure strata comparable with stages 1 and 2 hypertension in the U.S. population.Results-Of the 563,704 stroke patients evaluated, initial systolic blood pressure was <140 mm Hg in 173,120 patients (31%), 140-184 mm Hg in 315,207 patients (56%), 185-219 mm Hg in 74,586 patients (13%), and ≥220 mm Hg in 791 patients (0.1%). The mean time interval between presentation and evaluation was 40 ± 55, 33 ± 39, 25 ± 27, and 5 ± 1 minutes for increasing systolic blood pressure strata (p=0.009). A 3-and 8-fold higher rate of elevated blood pressure strata was observed in acute stroke than the existing rates of stages 1 and 2 hypertension in the U.S. population. Labetalol and hydralazine were used in 6,126 (1%) and 2,262 (0.4%) patients, respectively. Thrombolytics were used in 1,283 patients (0.4%), but only in those with SBP of 140-184 mm Hg.Conclusions-In a nationally representative large dataset, elevated blood pressure was observed in over 60% of the patients presenting with stroke to the emergency department. Elevated blood pressure was associated with an earlier evaluation, however, the use of thrombolytics was restricted to ischemic stroke patients with systolic blood pressure <185 mm Hg.
BACKGROUND AND PURPOSE:Although recanalization is the goal of thrombolysis, it is well recognized that it fails to improve outcome of acute stroke in a subset of patients. Our aim was to assess the rate of and factors associated with "futile recanalization," defined by absence of clinical benefit from recanalization, following endovascular treatment of acute ischemic stroke.
Decline in serum glucose concentration correlated with reduction in proportion of subjects with hematoma expansion and poor clinical outcome. These results provide a justification for a randomized controlled clinical trial to evaluate the efficacy of aggressive serum glucose reduction in reducing death and disability among patients with ICH.
Background and Purpose
The reliability of hematoma volume (HV) measurement using the ‘ABC/2’ method in multicenter clinical trials is unknown. We determined the accuracy of ABC/2 method as an on-site test in comparison with the gold standard central HV-assessment and semiautomatic HV-assessment.
We analyzed data from an acute intracerebral hemorrhage (ICH) multicenter clinical trial. HV was measured by site investigators to determine enrollment eligibility (<60 cm3) using the ABC/2 method (on-site HV), and independently by the core-imaging laboratory using computer-based analysis (MIPAV HV). HV was also measured by ABC/2 method (central HV) at the core-imaging laboratory to assess the difference in measurements between on-site (multiple raters with variable experiences) and central (single experienced rater) HVs.
Fifty-six subjects were analyzed (mean age 62±15 years; 45% women). On site HV values showed a significantly lower correlation with the MIPAV HV (r=0.63) than central HV and MIPAV HV (r=0.93) values. The correlation between on-site HV and central HV values was modest (r=0.51). A total of 73% of the central HVs were within 25% of the corresponding MIPAV HVs, whereas only 46% of the on-site HVs was within 25% of the corresponding MIPAV HVs (p<0.001). One protocol violation occurred due to inaccuracy of on-site HV measurement.
On-site HV measurements showed high variability but the impact on the eligibility determination was small. Centralized re-measurements of HVs with feedback to the sites may increase the reliability of the on-site HV measurements.
We found that new or additional recanalization occurs in one-fourth of the patients within 24 h of endovascular treatment and is not associated with any adverse consequences. Subacute reocclusion occurs infrequently after endovascular treatment.
The results of primary angioplasty and primary stent placement were comparable at intermediate follow-up examination after the procedure. The results highlight the need for carefully designed, randomized clinical trials to determine the precise value of stent placement in the intracranial circulation.
scite is a Brooklyn-based startup that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.