A pilot study of drug-induced hypertension for treatment of acute stroke

Abstract

The aim of this pilot study was to determine whether the use of induced hypertension in acute stroke is feasible and associated with neurologic improvement. Phenylephrine was used to raise the systolic blood pressure in patients with acute stroke by 20%, not to exceed 200 mmHG: Of 13 patients treated, 7 improved by 2 points on the NIH Stroke SCALE: No systemic or neurologic complications were seen. The authors conclude that induced hypertension in acute stroke is feasible and likely safe and can improve the neurologic examination in some patients.

Induced-hypertension in progressing lacunar infarction

“…Results of our study supported that phenylephrine inducedhypertension is a beneficial way to restore motor progression in patients with progressing lacunar infarction, concurring with prior studies [5,[13][14][15][16][17]21]. There has been no clear explanation on the mechanism of progressing lacunar infarction and motor recovery after induced hypertension [5,[22][23][24][25].…”

“…However, it was not the predictor when applying the Model 1 criterion. Previous studies have used various goals of BP elevation for the restoration in acute ischemic stroke, there are reports showing that patients with 20% or more BP elevation was significantly associated with good outcome in ischemic stroke patients [14][15][16]. According to Ohm's law of hemodynamics, cerebral perfusion pressure can be directly correlated with cerebral blood flow in the perforating arteries due to the lack of resistant arterioles [31].…”

“…DWI = diffusion weighted image; BG = basal ganglia; CR = corona radiata. [14,15,17]. This low adverse event rate is due to the low affinity of phenylephrine to the beta receptor of the heart and because of the lower coincidence of coronary artery disease, administration of phenylephrine can be a safer option to patients with progressing lacunar infarction [32].…”

“…Induction was at a rate of 0.5 mg/h and was titrated every 4 h to reach target blood pressure (BP) or a maximum systolic BP of 220 mm Hg. Target BP was defined as a 20% increase of initial systolic BP [14]. When NIHSS motor score was stable for the last 24 h, motor stabilization time was defined as the time elapsed from motor progression to motor stabilization (ie.…”

“…However, there have been no comparative studies on the effect of induced-hypertension in patients with progressing lacunar infarction, although preliminary studies have suggested that inducedhypertension therapy could play an advantageous role in large arterial atherosclerotic infarction with ischemic penumbra having impaired cerebral autoregulation [13][14][15][16][17]. Therefore, we investigated the outcome of phenylephrine induced-hypertension and which factors were related to the clinical response of induced-hypertension therapy in patients with lacunar infarction with early motor deterioration.…”