Management of Blood Pressure After Acute Ischemic Stroke

Bulwa, Zachary; Gomez, Camilo R.; Morales-Vidal, Sarkis; Biller, José

doi:10.1007/s11910-019-0941-z

Cited by 11 publications

(9 citation statements)

References 77 publications

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“…23 Preexisting hypertension, an acute stress response to the neurological insult, and injury to central autonomic pathways or altered baroreceptor sensitivity may also contribute to abnormally high BP levels. 24–26 In most patients, BP spontaneously normalizes over time, supporting a transient and stroke-specific mechanism. 27 However, our data demonstrate that the elevation and temporal course of BP following stroke are not uniform and vary at the level of the individual, both in terms of degree and duration.…”

Section: Discussionmentioning

confidence: 89%

Blood Pressure Trajectory Groups and Outcome After Endovascular Thrombectomy: A Multicenter Study

Petersen

Kodali

Meng

et al. 2022

Stroke

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Background and Purpose: Elevated blood pressure after endovascular thrombectomy (EVT) has been associated with an increased risk of hemorrhagic transformation and poor functional outcomes. However, the optimal hemodynamic management after EVT remains unknown, and the blood pressure course in the acute phase of ischemic stroke has not been well characterized. This study aimed to identify patient subgroups with distinct blood pressure trajectories after EVT and study their association with radiographic and functional outcomes. Methods: This multicenter retrospective cohort study included consecutive patients with anterior circulation large-vessel occlusion ischemic stroke who underwent EVT. Repeated time-stamped blood pressure data were recorded for the first 72 hours after thrombectomy. Latent variable mixture modeling was used to separate subjects into five groups with distinct postprocedural systolic blood pressure (SBP) trajectories. The primary outcome was functional status, measured on the modified Rankin Scale 90 days after stroke. Secondary outcomes included hemorrhagic transformation, symptomatic intracranial hemorrhage, and death. Results: Two thousand two hundred sixty-eight patients (mean age [±SD] 69±15, mean National Institutes of Health Stroke Scale 15±7) were included in the analysis. Five distinct SBP trajectories were observed: low (18%), moderate (37%), moderate-to-high (20%), high-to-moderate (18%), and high (6%). SBP trajectory group was independently associated with functional outcome at 90 days ( P <0.0001) after adjusting for potential confounders. Patients with high and high-to-moderate SBP trajectories had significantly greater odds of an unfavorable outcome (adjusted odds ratio, 3.5 [95% CI, 1.8–6.7], P =0.0003 and adjusted odds ratio, 2.2 [95% CI, 1.5–3.2], P <0.0001, respectively). Subjects in the high-to-moderate group had an increased risk of symptomatic intracranial hemorrhage (adjusted odds ratio, 1.82 [95% CI, 1–3.2]; P =0.04). No significant association was found between trajectory group and hemorrhagic transformation. Conclusions: Patients with acute ischemic stroke demonstrate distinct SBP trajectories during the first 72 hours after EVT that have differing associations with functional outcome. These findings may help identify potential candidates for future blood pressure modulation trials.

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Section: Discussionmentioning

confidence: 89%

Blood Pressure Trajectory Groups and Outcome After Endovascular Thrombectomy: A Multicenter Study

Petersen

Kodali

Meng

et al. 2022

Stroke

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“…Managing hypertension in acute ischemic stroke can be cumbersome because increased BP can be beneficial as a compensatory physiological regulation to inadequate localized cerebral perfusion pressure while increasing cerebral hemorrhagic risk [ 47 ]. Reducing the cerebral perfusion pressure could lead to expansion of the infarction zone as a consequence of further reducing perfusion to ischemic tissues [ 48 ].…”

Section: Managementmentioning

confidence: 99%

The Management of Hypertensive Emergencies—Is There a “Magical” Prescription for All?

Balahura

Moroi

Scafa-Udriște

et al. 2022

JCM

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Hypertensive emergencies (HE) represent high cardiovascular risk situations defined by a severe increase in blood pressure (BP) associated with acute, hypertension mediated organ damage (A-HMOD) to the heart, brain, retina, kidneys, and large arteries. Blood pressure values alone do not accurately predict the presence of HE; therefore, the search for A-HMOD should be the first step in the management of acute severe hypertension. A rapid therapeutic intervention is mandatory in order to limit and promote regression of end-organ damage, minimize the risk of complications, and improve patient outcomes. Drug therapy for HE, target BP, and the speed of BP decrease are all dictated by the type of A-HMOD, specific drug pharmacokinetics, adverse drug effects, and comorbidities. Therefore, a tailored approach is warranted. However, there is currently a lack of solid evidence for the appropriate treatment strategies for most HE. This article reviews current pharmacological strategies while providing a stepwise, evidence based approach for the management of HE.

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“…Studies have shown that elevated blood pressure is observed in about 75% of patients, which is associated with poorer outcomes for these individuals. Conversely, lowering blood pressure reduces the risk of stroke [22][23][24]. During the acute phase of ischemic stroke, blood pressure management is also beneficial for preventing hemorrhagic transformation [25].…”

Section: Role Of Hypertension In Strokementioning

confidence: 99%

Impact of Cardiovascular Diseases on Ischemic Stroke Outcomes

Huber¹,

Wang²,

Wang³

2022

J. Integr. Neurosci.

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Stroke induces complex pathological cascades in the affected brain area, leading to brain injury and functional disability. To fight against cerebral ischemia/reperfusion-induced neuronal death, numerous neuroprotective strategies and reagents have been studied. However, translation of these neuroprotective drugs to clinical trials has been unsuccessful. To date, the tissue plasminogen activator is still the only FDA-approved drug for treating ischemic stroke. Thus, it is obligatory to identify and validate additional therapeutic strategies for stroke. A stroke rarely occurs without any other pathophysiological condition; but instead, it often has multi-morbidity conditions, one of which is cardiac disease. Indeed, up to half of the stroke cases are associated with cardiac and large artery diseases. As an adequate blood supply is essential for the brain to maintain its normal function, any pathophysiological alterations in the heart are frequently implicated in stroke outcomes. In this review, we summarize some of the cardiovascular factors that influence stroke outcomes and propose that considering these factors in designing stroke therapies should enhance success in clinical trials. We also highlight the recent advances regarding the potential effect of protein aggregates in a peripheral organ, such as in the heart, on ischemic stroke-caused brain injury and functional recovery. Including these and other comorbidity factors in the future therapeutic strategy designs should facilitate translational success toward developing effective combinational therapies for the disorder.

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Management of Blood Pressure After Acute Ischemic Stroke

Cited by 11 publications

References 77 publications

Blood Pressure Trajectory Groups and Outcome After Endovascular Thrombectomy: A Multicenter Study

Blood Pressure Trajectory Groups and Outcome After Endovascular Thrombectomy: A Multicenter Study

The Management of Hypertensive Emergencies—Is There a “Magical” Prescription for All?

Impact of Cardiovascular Diseases on Ischemic Stroke Outcomes

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