The changes in blood pressure after acute stroke: abolishing the ‘white coat effect’ with 24‐h ambulatory monitoring

Harper, GD; Fotherby, Martin D.; Panayiotou, B; Castleden, C. M.; Potter, John F.

doi:10.1111/j.1365-2796.1994.tb01084.x

Cited by 52 publications

(52 citation statements)

References 8 publications

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“…18,19 Additionally, it provides high number of readings and abolishes digit preference, allowing a more precise documentation of BP values in acute stroke. Therefore, the aim of the present study was to investigate in stroke subtypes of different aetiopathogenic mechanisms the relation of BP values during the first hours of ictus to demographic characteristics, stroke risk factors, concomitant diseases, stroke severity and acute stroke complications (brain oedema and haemorrhagic transformation), by means of 24-h BP monitoring.…”

Section: Introductionmentioning

confidence: 99%

Factors influencing acute blood pressure values in stroke subtypes

et al. 2004

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The aim of this prospective observational study was to determine the association of acute blood pressure values with independent factors (demographic, clinical characteristics, early complications) in stroke subgroups of different aetiology. We evaluated data of 346 first-ever acute (o24 h) stroke patients treated in our stroke unit. Casual and 24-h blood pressure (BP) values were measured. Stroke risk factors and stroke severity on admission were documented. Strokes were divided into subgroups of different aetiopathogenic mechanism. Patients were imaged with CT-scan on admission and 5 days later to determine the presence of brain oedema and haemorrhagic transformation. The relationship of different factors to 24-h BP values (24-h BP) was evaluated separately in each stroke subgroup. In large artery atherosclerotic stroke (n ¼ 59), history of hypertension and stroke severity correlated with higher 24-h BP respectively. In cardioembolic stroke (n ¼ 87), history of hypertension, stroke severity, haemorrhagic transformation and brain oedema were associated with higher 24-h BP, while heart failure with lower 24-h BP. History of hypertension and coronary artery disease was related to higher and lower 24-h BP, respectively, in lacunar stroke (n ¼ 75). In patients with infarct of undetermined (n ¼ 57) cause 24-h BP were mainly influenced by stroke severity and history of hypertension. An independent association between higher 24-h BP and history of hypertension and cerebral oedema was documented in intracerebral haemorrhage (n ¼ 68). In conclusion, different factors influence acute BP values in stroke subtypes of different aetiology. If the clinical significance of these observations is verified, a differentiated approach in acute BP management based on stroke aetiology may be considered.

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Section: Introductionmentioning

confidence: 99%

Factors influencing acute blood pressure values in stroke subtypes

et al. 2004

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“…1 Because cerebral autoregulation is impaired after an acute stroke, cerebral blood flow is believed to be very sensitive to changes in systemic BP. Therefore, elevation of BP after acute stroke may be of benefit in terms of increasing cerebral blood flow in the ischemic areas of brain.…”

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confidence: 99%

Effect of Blood Pressure During the Acute Period of Ischemic Stroke on Stroke Outcome

Aslanyan

Fazekas

Weir

et al. 2003

Stroke

136

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Background and Purpose-The effects of blood pressure (BP) and its fluctuations during the acute phase on the clinical course of ischemic stroke are incompletely understood. We tested the hypotheses that baseline mean arterial BP [MAPϭ(2ϫdiastolic BPϩsystolic BP)/3], weighted average MAP, and an increase or decrease of Ͼ30% from baseline MAP are independently associated with stroke outcome. Methods-We studied the 1455 patients with ischemic stroke in the Glycine Antagonist (Gavestinel) in Neuroprotection (GAIN) International Trial. BP management was at the discretion of investigators and was measured at 0, 0.5, 4, 12, 12.25, 60, and 60.25 hours. Outcome was assessed by mortality, Barthel Index (dead or 0 to 55 versus 60 to 90 versus Ն95), National Institutes of Health Stroke Scale (NIHSS) score (dead or Ն2), and Rankin Scale (dead or Ն2). Cox proportional-hazards and stepwise logistic regression modeling corrected for demography, medical history, stroke severity, and clinical subtype.

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“…It is well known that BP levels are commonly elevated during acute stroke and fall spontaneously during subsequent days. [2][3][4] Most studies were based on casual measurements and included only a few very old patients. 2,4,19 The advantages of 24H BPM compared with casual BP values is that more measurements are yielded over time, information on BP load and variability are generated and the white coat effect and observer bias are eliminated.…”

Section: Discussionmentioning

confidence: 99%

“…There was no long-term follow-up. 3,[20][21][22][23][24][25] In the present study, we examined very old patients with acute stroke and used both admission casual BP levels and 24H BPM. Previous studies have demonstrated contradictory results regarding the effect of admission BP levels on outcomes in patients with acute stroke.…”

Section: Discussionmentioning

confidence: 99%

“…After acute stroke, elevated BP usually returns to normal within a few days. [2][3][4] Elevated BP during an acute ischemic stroke might be either advantageous by improving cerebral perfusion to the ischemic tissue or detrimental by exacerbating edema and hemorrhagic transformation of the ischemic tissue. 1 If BP elevation during acute stroke perfuses jeopardized brain tissue around the infracted area, it should be associated with favorable prognosis.…”

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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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The changes in blood pressure after acute stroke: abolishing the ‘white coat effect’ with 24‐h ambulatory monitoring

Cited by 52 publications

References 8 publications

Factors influencing acute blood pressure values in stroke subtypes

Factors influencing acute blood pressure values in stroke subtypes

Effect of Blood Pressure During the Acute Period of Ischemic Stroke on Stroke Outcome

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

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