Characteristics of Blood Pressure Profiles as Predictors of Long-Term Outcome After Acute Ischemic Stroke

Mei, Yong; Diener, Hans‐Christoph; Kaste, Markku; Mau, Jochen

doi:10.1161/01.str.0000189998.74892.24

Cited by 103 publications

(98 citation statements)

References 32 publications

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“…34,37,41 We did not find an association between BP variability during the first 24 hours and short-and long-term outcome. In patients with acute stroke treated with intravenous thrombolysis, high BP variability led to a poor outcome.…”

Section: -31contrasting

confidence: 68%

“…The rate of elevated BP during acute stroke in our study was lower than the rate described by others. 23,36,37 The low rate of elevated BP during acute stroke may be because of the older age of our patients, and the fact that we used 24H BPM. 38 It is possible that very old subjects exhibit a smaller protective increase in BP during acute stroke.…”

Section: -31mentioning

confidence: 99%

“…Yong et al 37 found that lower mean levels of systolic or diastolic BP during the first 72 hours were independent predictors of favorable outcome at 90 days. In their study, BP was repeatedly manually measured every 2 hours within the first 20 hours and then every 4 hours between 20 and 72 hours after admission.…”

Section: -31mentioning

confidence: 99%

“…In patients with acute stroke treated with intravenous thrombolysis, high BP variability led to a poor outcome. 34,37 and Kellert et al 41 may be explained by the different methods of BP measurements and by the index of variability used. We used the simple index of SD, whereas others used a more complicated equation, which is less practical in daily life.…”

Section: -31mentioning

confidence: 99%

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Systolic Blood Pressure During Acute Stroke Is Associated With Functional Status and Long-term Mortality in the Elderly

Weiss

Beloosesky

Kenett

et al. 2013

Stroke

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Awareness of the impact of BP levels during acute stroke on the short-and long-term outcome is crucial for the management of these patients. We, therefore, designed a study to evaluate the impact of admission BP levels assessed by casual BP measurements and 24H BPM on short-and long-term outcome in very elderly stroke patients. Subjects and Methods Study PopulationAll study patients were consecutively admitted to an acute geriatric ward with acute stroke between May 15, 2007, and March 15, 2011, and evaluated on admission. Subjects were included if they had had a documented acute stroke within 24 hours before admission. Ischemic stroke and intracranial hemorrhage were diagnosed by clinical findings and head computerized tomography. Patients <70 years of age, and patients with transient ischemic attacks, or other causes of acute neurological deficit were excluded. Further exclusions included patients Background and Purpose-The prognostic value of blood pressure (BP) levels during acute stroke has not been adequately studied. Most studies do not use continuous BP measurements, and patients are followed only for a short period. We designed a study to assess, with 24-hour BP monitoring (24H BPM), the impact of BP levels during the first day of stroke, on the short-term functional status and long-term mortality in elderly patients. Methods-We studied 177 patients with acute stroke (89 men), mean age 84±6 years. BP was measured on admission and 24H BPM was recorded within 24 hours of admission. After 7 days, patients were assessed for functional status according to the modified Rankin Scale and were subsequently followed up for mortality ≤5 years (mean, 2.07±1.48). Results-After 7 days, functional status improved and modified Rankin Scale decreased from 4.2 to 3.7. Follow-up analysis disclosed that 71 patients (27 men and 44 women) had died. Mortality rate was higher in women (50% versus 30%; P<0.01) and in patients with a history of congestive heart failure. Only average systolic BP, recorded by 24H BPM, predicted short-term functional status and long-term mortality. Cox proportional hazards model analysis demonstrated that age, sex, congestive heart failure, and average systolic BP >160 mm Hg, recorded by 24H BPM, were associated with increased mortality. Conclusions-High systolic BP recorded by 24H BPM on the first day of stroke was found to be associated with unfavorable short-term functional status and long-term mortality in elderly patients. (Stroke. 2013;44:2434-2440.)

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Section: -31contrasting

confidence: 68%

Section: -31mentioning

confidence: 99%

Section: -31mentioning

confidence: 99%

Section: -31mentioning

confidence: 99%

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Systolic Blood Pressure During Acute Stroke Is Associated With Functional Status and Long-term Mortality in the Elderly

Weiss

Beloosesky

Kenett

et al. 2013

Stroke

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“…Yong et al reported the effect of blood pressure before and after t-PA injection on cerebral hemorrhage and patient prognosis, using the patient cohort in the ECASS study. The results obtained with the cohort from the first ECASS study indicated that Higher systolic BP or diastolic BP at baseline were associated with favorable outcome assessed on modified mRS at 90 days, lower within-patient 0-to 72-hour average SBP or DBP implied favorable outcome, and reduced variability of 0-to 72-hour DBP profile was an independent predictor of favorable outcome 5 . The results obtained with the cohort from the second ECASS study showed that higher systolic pressure before t-PA injection, higher maximum/average systolic pressure for 24 hours post-injection, and larger changes in systolic pressure were associated with higher frequency of cerebral hemorrhage and worsening of neurological symptoms by day 7 from the initial attack 6 .…”

Section: Introductionmentioning

confidence: 96%

Blood pressure variability and hemorrhagic transformation after intravenous thrombolysis in acute ischemic stroke

Lee¹

2016

J Neurol Neuromedicine

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The effectiveness of intravenous tissue plasminogen activator (t-PA) is well established in hyperacute ischemic stroke. Despite its efficacy, spontaneous intracranial hemorrhage after t-PA is a severe complication associated with poor prognosis. We evaluated the role of blood pressure (BP) and BP variability, measured before and after injection of t-PA within 24 hours. Herein, 116 patients were enrolled in this study. BP (systolic blood pressure, diastolic blood pressure, and pulse pressure) were recorded before t-PA and every hour after t-PA for 24 hours. The BP profiles were characterized by initial, mean, maximum (max), minimum (min), max-min, and standard deviation (sd). The intracranial hemorrhage was assessed via computed tomography, 24-36 hours after injection of t-PA. The hemorrhagic transformation was classified using clinical and radiological criteria as follows: hemorrhagic transformation (HT), parenchymal hemorrhage (PH), and symptomatic hemorrhage (SH). The intracranial hemorrhage occurred as follows: HT 25.52% (n=25), PH 10.81% (n=12), SH 3.60% (n=4). The PPsd during the 24-hour period post-injection (24h PPsd) was significantly higher in patients with HT (14.57±0.76 vs. 11.84±0.39, 95% confidence interval [CI] 1.07-4.40, p<0.001) and PH (16.74±4.17 vs. 11.93±3.48, p<0.001). The odds ratio per 5 mmHg of 24h-PPsd was 2.41 (95% CI 1.23-4.72) in HT and 4.76 (95% CI 1.60-12.17) in PH. The variability in pulse pressure during the first 24 hours may be associated with hemorrhagic transformation after thrombolytic therapy with t-PA in hyperacute infarction.

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Thrombolysis for acute ischaemic stroke

Wardlaw

Murray

Berge

et al. 2009

Cochrane Database of Systematic Reviews

276

218

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Characteristics of Blood Pressure Profiles as Predictors of Long-Term Outcome After Acute Ischemic Stroke

Cited by 103 publications

References 32 publications

Systolic Blood Pressure During Acute Stroke Is Associated With Functional Status and Long-term Mortality in the Elderly

Systolic Blood Pressure During Acute Stroke Is Associated With Functional Status and Long-term Mortality in the Elderly

Blood pressure variability and hemorrhagic transformation after intravenous thrombolysis in acute ischemic stroke

Thrombolysis for acute ischaemic stroke

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