Blood Pressure in Acute Stroke

Abstract

This study examines blood pressure (BP) and independent factors related to BP in the acute phase of stroke. The study is part of the community-based Copenhagen Stroke Study. In a multivariate regression model we analyzed the impact of clinical and medical factors on admission BP. BP declined with increasing time from stroke onset with a total of 8/4 mm Hg. Independent factors related to diastolic BP were ischemic heart disease (–3.9 mm Hg), male gender (2.2 mm Hg), known hypertension prior to stroke (8.6 mm Hg), and primary hemorrhage (9.7 mm Hg). Independent factors related to systolic BP were age (3.6 mm Hg/10-year increase), atrial fibrillation (–7.2 mm Hg), ischemic heart disease (–6.0 mm Hg), intracerebral hemorrhage (13.3 mm Hg), and known hypertension prior to stroke (16.3 mm Hg). No independent relations were seen between BP and diabetes, claudication, previous stroke, smoking, daily alcohol consumption, initial stroke severity and lesion size. The increase in BP in the acute phase of stroke is a uniform response to the ischemic event per se. BP is not related to stroke severity. Several factors are independently related to the BP level in acute stroke. The clinical significance of this is yet to be tested, but these factors may contribute to the seemingly complex relation between BP and outcome.

Lymphocyte Apoptosis: Role of Uremia and Permeability of Dialysis Membrane

“…Therefore Fas expression occurs before apoptosis and may not be simultaneous to Annexin V staining. An increase in apoptosis of lymphocytes from uremic patients has been also reported by others investigators [14]; they also showed that apoptosis was accompanied by increased Fas expression, which may explain the mechanism of apoptosis.…”

“…Different authors [25, 26] have observed that persistent activation of lymphocytes and other cells may produce genomic instability that make these cells more susceptible to apoptosis. Recent reports [14, 21] have shown which lymphocytes from uremic patients exhibit characteristics of activated cells such as increased expression of activation molecules and the production of cytokines.…”

“…Annexin binds only to cells in which phosphatidylserine has been translocated outside the membrane; this is an event that occurs early and at intermediate stages of cell apoptosis [15, 16]. Previous work by us and others has shown that Annexin V staining is an appropriate method for assessing cell apoptosis [5, 6, 13, 14]. Cells were processed following the instructions of the manufacturer.…”

“…Moreover, the effect of hemodialysis membrane on lymphocyte apoptosis may not be entirely related to the bioincompatibility induced inflammatory response but also to the efficacy of dialysis in the clearance of uremic toxins. It is known that uremia has a direct effect on increasing cell apoptosis [13, 14]; however, it remains to be evaluated if apoptosis is modified by the clearance of different size uremic toxins. A first approach to answer this question would be to investigate the degree of lymphocyte apoptosis in patients dialyzed with different permeability membranes.…”

Non-Pharmacological Neuroprotection: Role of Emergency Stroke Management

“…Several observational studies have reported the relationship between raised BP levels and a poor prognosis [83,84,85,86,87], although some authors have demonstrated better outcomes in patients with high initial BP [88, 89]. A systolic pressure BP (SBP) >160 mm Hg within the first 24 h has been related to a poor outcome [87].…”