BACKGROUND: Management of blood pressure (BP) in acute ischemic stroke is controversial. The present study aims to explore the association between baseline BP levels and BP change and outcome in the overall stroke population and in specific subgroups with regard to the presence of arterial hypertensive disease and prior antihypertensive treatment. METHODS: All patients registered in the Acute STroke Registry and Analysis of Lausanne (ASTRAL) between 2003 and 2009 were analyzed. Unfavorable outcome was defined as modified Rankin score more than 2. A local polynomial surface algorithm was used to assess the effect of BP values on outcome in the overall population and in predefined subgroups. RESULTS: Up to a certain point, as initial BP was increasing, optimal outcome was seen with a progressively more substantial BP decrease over the next 24-48 h. Patients without hypertensive disease and an initially low BP seemed to benefit from an increase of BP. In patients with hypertensive disease, initial BP and its subsequent changes seemed to have less influence on clinical outcome. Patients who were previously treated with antihypertensives did not tolerate initially low BPs well. CONCLUSION: Optimal outcome in acute ischemic stroke may be determined not only by initial BP levels but also by the direction and magnitude of associated BP change over the first 24-48 h.
BACKGROUND: Management of blood pressure (BP) in acute ischemic stroke is controversial. The present study aims to explore the association between baseline BP levels and BP change and outcome in the overall stroke population and in specific subgroups with regard to the presence of arterial hypertensive disease and prior antihypertensive treatment. METHODS: All patients registered in the Acute STroke Registry and Analysis of Lausanne (ASTRAL) between 2003 and 2009 were analyzed. Unfavorable outcome was defined as modified Rankin score more than 2. A local polynomial surface algorithm was used to assess the effect of BP values on outcome in the overall population and in predefined subgroups. RESULTS: Up to a certain point, as initial BP was increasing, optimal outcome was seen with a progressively more substantial BP decrease over the next 24-48 h. Patients without hypertensive disease and an initially low BP seemed to benefit from an increase of BP. In patients with hypertensive disease, initial BP and its subsequent changes seemed to have less influence on clinical outcome. Patients who were previously treated with antihypertensives did not tolerate initially low BPs well. CONCLUSION: Optimal outcome in acute ischemic stroke may be determined not only by initial BP levels but also by the direction and magnitude of associated BP change over the first 24-48 h.
Authors: Manuel Cappellari; Paolo Bovi; Giuseppe Moretto; Andrea Zini; Patrizia Nencini; Maria Sessa; Mauro Furlan; Alessandro Pezzini; Giovanni Orlandi; Maurizio Paciaroni; Tiziana Tassinari; Gaetano Procaccianti; Vincenzo Di Lazzaro; Luigi Bettoni; Carlo Gandolfo; Giorgio Silvestrelli; Maurizia Rasura; Giuseppe Martini; Maurizio Melis; Maria Vittoria Calloni; Fabio Chiodo-Grandi; Simone Beretta; Maria Guarino; Maria Concetta Altavista; Simona Marcheselli; Giampiero Galletti; Laura Adobbati; Massimo Del Sette; Armando Mancini; Daniele Orrico; Serena Monaco; Anna Cavallini; Rossella Sciolla; Francesco Federico; Umberto Scoditti; Fabio Brusaferri; Claudio Grassa; Luigi Specchio; Maria Roberta Bongioanni; Marco Sparaco; Mauro Zampolini; Gabriele Greco; Rinaldo Colombo; Bruno Passarella; Alessandro Adami; Domenico Consoli; Danilo Toni Journal: Neurology Date: 2013-01-23 Impact factor: 9.910