Treating Hypertension in Acute Ischemic Stroke

Spence, J. David

doi:10.1161/hypertensionaha.109.134486

Cited by 10 publications

(7 citation statements)

References 20 publications

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“…Previous study [41] has also shown that satisfactory control of SBP within 140 to 150 mm Hg was the optimal therapy for improving clinical outcome after acute IS. Therefore, our findings corroborated those of previous studies [42-44]. …”

Section: Discussionsupporting

confidence: 93%

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Effect of erythropoietin on level of circulating endothelial progenitor cells and outcome in patients after acute ischemic stroke

et al. 2011

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IntroductionErythropoietin (EPO) enhances the circulating level of endothelial progenitor cells (EPCs), which has been reported to be associated with prognostic outcome in ischemic stroke (IS) patients. The aim of this study was to evaluate the time course of circulating EPC level and the impact of EPO therapy on EPC level and clinical outcome in patients after acute IS.MethodsIn total, 167 patients were prospectively randomized to receive either EPO therapy (group 1) (5,000 IU each time, subcutaneously) at 48 h and 72 h after acute IS, or serve as placebo (group 2). The circulating level of EPCs (double-stained markers: CD31/CD34 (E1), CD62E/CD34 (E2) and KDR/CD34 (E3)) was determined using flow cytometry at 48 h and on days 7 and 21 after IS. EPC level was also evaluated once in 60 healthy volunteers.ResultsCirculating EPC (E1 to E3) level at 48 h after IS was remarkably higher in patients than in control subjects (P < 0.02). At 48 h and on Day 7 after IS, EPC (E1 to E3) level did not differ between groups 1 and 2 (all P > 0.1). However, by Day 21, EPC (E1 to E3) level was significantly higher in group 1 than in group 2 (all P < 0.03). Additionally, 90-day recurrent stroke rate was notably lower in group 1 compared with group 2 (P = 0.022). Multivariate analysis demonstrated that EPO therapy (95% confidence interval (CI), 0.153 to 0.730; P = 0.006) and EPC (E3) (95% CI, 0.341 to 0.997; P = 0.049) levels were significantly and independently predictive of a reduced 90-day major adverse neurological event (MANE) (defined as recurrent stroke, National Institutes of Health Stroke scale ≥8, or death).ConclusionsEPO therapy significantly improved circulating EPC level and 90-day MANE.Trial registration numberISRCTN: ISRCTN96340690

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Section: Discussionsupporting

confidence: 93%

“…The impact of blood pressure on clinical outcome after acute IS has been extensively investigated [42-44]. Excessive elevation, reduction, and variability in blood pressure have been reported to be independent prognostic predictors for poor clinical outcome after acute IS [43,44].…”

Section: Discussionmentioning

confidence: 99%

Effect of erythropoietin on level of circulating endothelial progenitor cells and outcome in patients after acute ischemic stroke

et al. 2011

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“…Of the patients studied, 80% had hypertension, demonstrating the high prevalence of this risk factor in critical care stroke patients, as observed in other studies 9,10 . Nevertheless, few studies have evaluated the association between BP and the case fatality ratio in acute stroke.…”

Section: Discussionsupporting

confidence: 81%

Association between blood pressure and acute phase stroke case fatality rate: a prospective cohort study

Furlan

Bazan

Braga

et al. 2018

Arq. Neuro-Psiquiatr.

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“…Chronic hypertension causes cerebral vascular remodeling and dysfunction, leading to loss of the cerebral blood flow (CBF) auto-regulation system. 19,20 Under the lost CBF auto-regulation system, further increase of high BP in acute ischemic stroke can promote cerebrovascular over-perfusion and therefore exacerbate ischemic injury by aggravating cerebral edema. 19,20 This reversal of BP elevation by RDN was associated with a significant reduction of CBF in the reperfusion period.…”

Section: Discussionmentioning

confidence: 99%

“…19,20 Under the lost CBF auto-regulation system, further increase of high BP in acute ischemic stroke can promote cerebrovascular over-perfusion and therefore exacerbate ischemic injury by aggravating cerebral edema. 19,20 This reversal of BP elevation by RDN was associated with a significant reduction of CBF in the reperfusion period. 18 As recently demonstrated, cerebral superoxide levels were significantly reduced by RDN post-treatment, and associated with the decrease in cerebral gp91phox, a major subunit of nicotinamide adenine dinucleotide phosphate oxidase.…”

Section: Discussionmentioning

confidence: 99%

Long-term benefit of renal denervation on blood pressure control in a patient with hemorrhagic stroke

Versaci

Andò

Chiocchi

et al. 2019

SAGE Open Medical Case Reports

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A 49-year-old man with malignant hypertension had been admitted with hemorrhagic stroke. Refractory hypertension had been observed during hospitalization and the decision had been made to perform renal denervation. A significant blood pressure reduction was obtained immediately after renal denervation and persists at 2-year follow-up. This case demonstrates the long-term sustained efficacy of renal denervation performed in the acute phase of hemorrhagic stroke. In addition, it supports the notion that renal denervation–induced normalization of blood pressure may contribute to better outcomes in a challenging setting such as intracranial bleeding.

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Treating Hypertension in Acute Ischemic Stroke

Cited by 10 publications

References 20 publications

Effect of erythropoietin on level of circulating endothelial progenitor cells and outcome in patients after acute ischemic stroke

Effect of erythropoietin on level of circulating endothelial progenitor cells and outcome in patients after acute ischemic stroke

Association between blood pressure and acute phase stroke case fatality rate: a prospective cohort study

Long-term benefit of renal denervation on blood pressure control in a patient with hemorrhagic stroke

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