Blood Pressure and Functional Recovery in Acute Ischemic Stroke

Neurology Service/IDIBAPS, Hospital Clínic, Barcelona, Spain.
Stroke (Impact Factor: 5.72). 09/1998; 29(9):1850-3. DOI: 10.1016/S0895-7061(01)01591-6
Source: PubMed


The relevance of elevated blood pressure in acute ischemic stroke and its most appropriate management are unresolved. We aimed to evaluate the rate of functional recovery with relation to early blood pressure management in patients with ischemic stroke.
Four hundred eighty-one consecutive ischemic stroke patients were admitted to the Neurology Service within 20.9+/-10.5 hours of symptoms onset as part of the Barcelona Downtown Stroke Registry, including 235 patients who received oral antihypertensive agents within <24 hours after stroke onset. Demographic, clinical (Mathew scale), and CT scan findings were collected prospectively. Mean arterial pressure (MAP) was recorded before hospital arrival and at 7 AM on days 1, 2, and 7 of hospitalization. The primary end point was complete functional recovery at day 7 defined as a score of 0 to 1 on the modified Rankin scale.
Two hundred fifty-two patients achieved complete recovery on day 7. Using logistic regression, independent predictors of complete recovery included mild impairment at stroke presentation, lack of history of hypertension, and absence of brain edema on CT scan. Also, a 20% to 30% drop in MAP on day 2 after stroke onset almost tripled the odds of full recovery (odds ratio, 2.9; 95% CI, 1.3 to 6.3). MAP tended to normalize after stroke in all subjects, more rapidly if hypotensive agents were administered. Brain edema was also less frequent in patients with a greater drop in blood pressure. Despite the fact that a drop in MAP >30% from baseline was observed in 49 patients, this preceded worsening stroke in only 4 patients. Conversely, worsening stroke occurred in 51 patients despite stable blood pressure.
These results suggest that complete recovery in ischemic stroke is facilitated by a moderate blood pressure reduction when brain edema develops, most likely as the result of a more adequate cerebral perfusion pressure. Conversely, stroke worsening due to pharmacological hypoperfusion is exceptional.

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    • "The Barcelona Downtown stroke registry found that early decrease of systolic blood pressure by 20–30% was associated with full recovery (OR 2.9, 95% CI 1.3–6.3) [16]. A decrease in systolic blood pressure within 12 hours was associated with recanalization of the vessel [18]. "
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    • "13, 14, 15, 16 This increased blood pressure (BP) falls spontaneously within the first week, without specific antihypertensive therapy.17 Severe hypertension in the early phase of acute ischemic stroke is another sign associated with poor functional outcome and higher mortality.18, 19, 20 As yet, however, there are only limited data on the association of SAP with severe arterial hypertension in patients with acute stroke. "
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    • "As a consequence, AS is a specific state of risk (Parmeggiani, 1991). Moreover, between 10 and 40% of strokes occur during the night (Marshall, 1977; van der Windt & van Gijn, 1988; Chamorro et al. 1998; Basetti & Aldrich, 1999), and a low blood pressure may contribute to night-time stroke (Basetti & Aldrich, 1999). This study was designed to assess the cerebral circulation's ability to respond to hypotension during sleep. "
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