Differences between hypertensive and non‐hypertensive ischemic stroke

Arboix, Adrià; Roig, H; Rossich, R; Martínez, ez María Mayda Oliva; Garcı́a-Eroles, Luis

doi:10.1111/j.1468-1331.2004.00910.x

Cited by 65 publications

(39 citation statements)

References 36 publications

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“…A high prevalence of chronic hypertension is observed among patients with stroke. It is, therefore, reasonable to assume that in at least a proportion of these patients, the elevated blood pressure is merely a reflection of inadequately treated or undetected chronic hypertension [26]. However, spontaneous reduction in the initial blood pressure over the next few days described previously in most patients is inconsistent with chronic hypertension [1][2][3][4].…”

Section: Discussionmentioning

confidence: 95%

Prevalence of elevated blood pressure in 563704 adult patients with stroke presenting to the ED in the United States

Qureshi¹,

Ezzeddine²,

Nasar³

et al. 2007

The American Journal of Emergency Medicine

390

245

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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.

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Section: Discussionmentioning

confidence: 95%

Prevalence of elevated blood pressure in 563704 adult patients with stroke presenting to the ED in the United States

Qureshi¹,

Ezzeddine²,

Nasar³

et al. 2007

The American Journal of Emergency Medicine

390

245

View full text Add to dashboard Cite

show abstract

“…Several factors can cause hypertensive response during acute stroke, including inadequately treated or undetected chronic hypertension before stroke onset, 35 increased sympathoadrenal tone with subsequent renin release and vasoconstriction because of impaired cardiac baroreceptor sensitivity, 36,37 and stress responses to hospitalization, urinary retention, or conscious disturbance; some of these do not last long. In our cohort, any components of admission BP or HR did not predict chronic outcomes.…”

Section: Discussionmentioning

confidence: 99%

Effects of 24-Hour Blood Pressure and Heart Rate Recorded With Ambulatory Blood Pressure Monitoring on Recovery From Acute Ischemic Stroke

Tomii

Toyoda

Suzuki

et al. 2011

Stroke

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Background and Purpose-This study used ambulatory blood pressure (BP) monitoring to generate BP and heart rate (HR) profiles soon after stroke onset and evaluated the association between determined values and 3-month stroke outcomes. Methods-We analyzed 24-hour ambulatory BP monitoring records from 104 patients with acute ischemic stroke.Ambulatory BP monitoring was attached at the second and eighth hospitalization days (Days 1 and 7). Both BP and HR were characterized using baseline, mean, maximum, and minimum values and coefficient of variation during 24-hour recording periods. Outcomes at 3 months were assessed as independence according to a modified Rankin Scale score of Յ2 and poor according to the score of Ն5. Results-Sixty-six (63%) patients achieved independence and 12 (11%)

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“…(We note that the risk estimate for diabetes, another established stroke risk factor, was higher for normotensives than for hypertensives.) Alternatively, different stroke types may occur in the absence of hypertension, 26 and stratification may result in a more homogeneous population.…”

Section: Discussionmentioning

confidence: 99%

Association of Phosphodiesterase 4D Polymorphisms With Ischemic Stroke in a US Population Stratified by Hypertension Status

Brophy

Rhees

et al. 2006

Stroke

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Background and Purpose-Phosphodiesterase 4D (PDE4D) underlies the STRK1 linkage peak for stroke on chromosome 5q12 identified in Iceland. We tested association of 13 single-nucleotide polymorphisms (SNPs) and 1 microsatellite in a nested case-control sample of elderly white women (Ͼ65 years of age) from the Study of Osteoporotic Fractures (SOF) in the United States. Methods-The genotypes of 248 women who experienced an incident ischemic stroke during an average of 5.4 years of follow-up were compared with 560 controls. Results-Marginal associations with stroke (PϽ0.10) were found for 3 polymorphisms. Stratification of the population by hypertension markedly strengthened the association. SNPs 9 (hazard ratio [HR], 0.48; 95% CI, 0.26 to 0.91), 42 (HR, 1.73; 95% CI, 1.10 to 2.70), 219 (HR, 1.73; 95% CI, 1.13 to 2.64), and 220 (HR, 1.56; 95% CI, 1.05 to 2.32) showed significant association with stroke (PϽ0.05) under a dominant model in subjects without hypertension at baseline, and SNP 175 was significantly associated with stroke under an additive model (HR, 0.76; 95% CI, 0.59 to 0.98) in subjects with hypertension. Furthermore, the microsatellite AC008818-1 showed association with stroke only in the nonhypertensive subjects. Based on results in Iceland, specific haplotypes were tested in SOF, and stratification by hypertension also affected these association results. Conclusion-These data are consistent with an association of the PDE4D gene with stroke in a non-Icelandic sample and suggest an effect of hypertension status.

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Differences between hypertensive and non‐hypertensive ischemic stroke

Cited by 65 publications

References 36 publications

Prevalence of elevated blood pressure in 563704 adult patients with stroke presenting to the ED in the United States

Prevalence of elevated blood pressure in 563704 adult patients with stroke presenting to the ED in the United States

Effects of 24-Hour Blood Pressure and Heart Rate Recorded With Ambulatory Blood Pressure Monitoring on Recovery From Acute Ischemic Stroke

Association of Phosphodiesterase 4D Polymorphisms With Ischemic Stroke in a US Population Stratified by Hypertension Status

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