Trends in admission blood pressure and stroke outcome in patients with acute stroke and transient ischemic attack in a National Acute Stroke registry

Koton, Silvia; Eizenberg, Yoav; Tanné, David; Grossman, Ehud

doi:10.1097/hjh.0000000000000797

Cited by 16 publications

(13 citation statements)

References 28 publications

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“…However, several previous studies also demonstrated that increased BP in acute phase may be detrimental to the brain edema and hemorrhage transformation 18–20 . So the relationship between early elevation in BP and prognosis remains controversial, some reports suggested that initially high blood pressure was associated with a poor prognosis 21–23 , while other study suggested that elevated BP contributed to a more favorable prognosis 8 or did not affect the prognosis 24 .…”

Section: Discussionmentioning

confidence: 97%

Different levels of blood pressure, different benefit from dual antiplatelet therapy in minor stroke or TIA patients

Tao

et al. 2017

Sci Rep

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The study aimed to evaluate whether the benefits of dual antiplatelet therapy would be influenced by blood pressure (BP) levels, among acute minor stroke or transient ischemic attack (TIA). In CHANCE (Clopidogrel in High-Risk Patients with Acute Nondisabling cerebrovascular Events) trail, Patients were stratified by systolic BP (SBP) and diastolic BP (DBP) level measured on admission, respectively, using the supine position BP within 24 hours after symptoms onset. The primary efficacy outcome was stroke recurrence, bleeding was the safety outcome. Patients with SBP ≥ 140 mmHg, dual antiplatelet treatment could reduce the risk of stroke recurrence significantly (HR 0.654, 95% CI 0.529–0.793, p < 0.001) than mono antiplatelet therapy. And patients with DBP ≥ 90 mmHg, clopidogrel-aspirin significantly reduced the risk of recurrent stroke (HR 0.588, 95% CI 0.463–0.746, p < 0.001), compared with aspirin alone. However, in patients with SBP < 140 mmHg or DBP < 90 mmHg, no significant difference was observed between clopidogrel plus aspirin and aspirin alone. there was no difference in bleeding episodes by treatment assignment across categories of SBP or DBP. Patients with SBP ≥ 140 mmHg or DBP ≥ 90 mmHg after minor stroke or TIA got more benefits from dual antiplatelet therapy. Bleeding risk from dual antiplatelet treatment did not increase among patients with higher BP level on admission.

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Section: Discussionmentioning

confidence: 97%

Different levels of blood pressure, different benefit from dual antiplatelet therapy in minor stroke or TIA patients

Tao

et al. 2017

Sci Rep

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“…2 Pasien stroke akut sering mengalami tekanan darah yang tinggi saat masuk rumah sakit, kondisi ini berhubungan dengan luaran yang buruk seperti perburukan defisit neurologis, stroke rekuren, dan kematian. 3,4 Patologi pada kondisi perdarahan intrakranial menyebabkan timbulnya tekanan intrakaranial serta penurunan tekanan darah sistemik. Hal ini selanjutnya mengakibatkan hipoperfusi dan infark di sekitar jaringan edema, sedangkan peningkatan tekanan darah dapat memperluas daerah edema di area sekitar infark atau perdarahan.…”

Section: Artikel Asli Putri Et Al 2018unclassified

“…Pembahasan Peningkatan tekanan darah saat masuk pada pasien stroke lazim terjadi, baik pada stroke iskemia maupun stroke perdarahan. 4 Hasil penelitian ini menunjukkan adanya hubungan tekanan darah saat masuk dengan mortalitas pasien dengan stroke perdarahan. Hal ini sesuai dengan penelitian yang dilakukan oleh Carlberg et al, bahwa terdapat kecenderungan terjadinya perdarahan berulang saat fase akut stroke pada pasien dengan tekanan darah sistemik yang tinggi.…”

Section: Artikel Asli Putri Et Al 2018unclassified

“…Hal ini diharapkan dapat menurunkan mortalitas pada stroke. 4 Penelitian yang dilakukan di Asia, terdapat hubungan antara kolesterol dengan stroke penyumbatan namun hubungan ini tidak ditemukan pada kasus stroke perdarahan. 4 Hasil tersebut berbeda dengan dengan hasil penelitian ini.…”

Section: Artikel Asli Putri Et Al 2018unclassified

“…4 Penelitian yang dilakukan di Asia, terdapat hubungan antara kolesterol dengan stroke penyumbatan namun hubungan ini tidak ditemukan pada kasus stroke perdarahan. 4 Hasil tersebut berbeda dengan dengan hasil penelitian ini. Kadar kolesterol dalam darah pasien berhubungan dengan mortalitas stroke perdarahan, walaupun hasilnya tidak bermakna ketika dilakukan uji multivariat.…”

Section: Artikel Asli Putri Et Al 2018unclassified

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Hubungan Tekanan Darah Pasien Saat Masuk Rumah Sakit Terhadap Mortalitas Pasien Dengan Stroke Perdarahan

et al. 2018

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Latar Belakang: Peningkatan tekanan darah umum terjadi pada fase akut stroke dan berhubungan dengan luaran klinis yang buruk. Hasil yang bervariasi ditunjukkan oleh studi terhadap tekanan darah pada fase akut stroke sebagai prediktor luaran klinis pasien. Tujuan: Untuk mengetahui hubungan tekanan darah pasien saat masuk rumah sakit terhadap mortalitas pasien dengan stroke perdarahan di Rumah Sakit Umum Pusat (RSUP) Dr Sardjito. Metode Penelitian: Metode penelitian menggunakan rancangan cohort retrospective dengan analisis independent sample T-Test dan Mann Whitney. Subyek penelitian adalah pasien yang dirawat di RSUP Dr. Sardjito Yogyakarta pada bulan Januari 2017 hingga Juni 2017. Subyek penelitian didiagnosis mengalami stroke perdarahan berdasarkan hasil pemeriksaan Computed Tomography (CT)-Scan kepala. Hasil: Terdapat 69 subjek penelitian dengan proporsi terbanyak laki laki (60,8%). Analisis bivariat menunjukkan nilai rerata sistolik (190,5 (±30), p=0,00), rerata diastolik (109 (±19,6), p=0,00), rereata Mean Arterial Pressure (MAP) (136 (±21,1), p=0,00) dan median Glukosa Darah Puasa (GDP) (115 (67-298), p=0,032) bermakna secara statistik terhadap kematian pasien dengan stroke perdarahan. Uji multivariat menunjukkan MAP memiliki korelasi positif terhadap mortalitas pasien (r=0,274: p=0,000). Simpulan: Nilai MAP berhubungan dengan mortalitas pada pasien dengan stroke perdarahan.

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Perfusion‐Dependent Cerebral Autoregulation Impairment in Hemispheric Stroke

Hecht

Schrammel

Neumann

et al. 2020

Annals of Neurology

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Objective Loss of cerebral autoregulation (CA) plays a key role in secondary neurologic injury. However, the regional distribution of CA impairment after acute cerebral injury remains unclear because, in clinical practice, CA is only assessed within a limited compartment. Here, we performed large‐scale regional mapping of cortical perfusion and CA in patients undergoing decompressive surgery for malignant hemispheric stroke. Methods In 24 patients, autoregulation over the affected hemisphere was calculated based on direct, 15 to 20‐minute cortical perfusion measurement with intraoperative laser speckle imaging and mean arterial blood pressure (MAP) recording. Cortical perfusion was normalized against noninfarcted tissue and 6 perfusion categories from 0% to >100% were defined. The interaction between cortical perfusion and MAP was estimated using a linear random slope model and Pearson correlation. Results Cortical perfusion and CA impairment were heterogeneously distributed across the entire hemisphere. The degree of CA impairment was significantly greater in areas with critical hypoperfusion (40–60%: 0.42% per mmHg and 60–80%: 0.46% per mmHg) than in noninfarcted (> 100%: 0.22% per mmHg) or infarcted (0–20%: 0.29% per mmHg) areas (*p < 0.001). Pearson correlation confirmed greater CA impairment at critically reduced perfusion (20–40%: r = 0.67; 40–60%: r = 0.68; and 60–80%: r = 0.68) compared to perfusion > 100% (r = 0.36; *p < 0.05). Tissue integrity had no impact on the degree of CA impairment. Interpretation In hemispheric stroke, CA is impaired across the entire hemisphere to a variable extent. Autoregulation impairment was greatest in hypoperfused and potentially viable tissue, suggesting that precise localization of such regions is essential for effective tailoring of perfusion pressure‐based treatment strategies. ANN NEUROL 2021;89:358–368

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Trends in admission blood pressure and stroke outcome in patients with acute stroke and transient ischemic attack in a National Acute Stroke registry

Abstract: Admission SBP in patients with acute stroke and TIA decreased from 2004 to 2010 and may have contributed to the improved outcome in these patients.

Cited by 16 publications

References 28 publications

Different levels of blood pressure, different benefit from dual antiplatelet therapy in minor stroke or TIA patients

Different levels of blood pressure, different benefit from dual antiplatelet therapy in minor stroke or TIA patients

Hubungan Tekanan Darah Pasien Saat Masuk Rumah Sakit Terhadap Mortalitas Pasien Dengan Stroke Perdarahan

Perfusion‐Dependent Cerebral Autoregulation Impairment in Hemispheric Stroke

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