Progress towards optimizing blood pressure control after reperfusion therapy for acute ischemic stroke

2021 ◽  
Author(s):  
Craig Anderson
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Blood Pressure Control ◽  
Pressure Control ◽  
Reperfusion Therapy

scholarly journals Prevalence of Inadequate Blood Pressure Control Among Veterans After Acute Ischemic Stroke Hospitalization

2011 ◽  
Vol 4 (4) ◽  
pp. 399-407 ◽  
Author(s):  
Christianne L. Roumie ◽  
Susan Ofner ◽  
Joseph S. Ross ◽  
Greg Arling ◽  
Linda S. Williams ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Blood Pressure Control ◽  
Pressure Control

scholarly journals Outcomes of Patients Requiring Blood Pressure Control Before Thrombolysis with tPA for Acute Ischemic Stroke

2015 ◽  
Vol 16 (7) ◽  
pp. 1002-1006 ◽  
Author(s):  
Bryan Darger ◽  
Nicole Gonzales ◽  
Rosa Banuelos ◽  
Hui Peng ◽  
Ryan Radecki ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Blood Pressure Control ◽  
Pressure Control

Abstract TMP56: Prediction of Primary Stroke: A Secondary Analysis of the SPRINT Trial

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Adam H de Havenon ◽  
Eric Goldstein ◽  
Stephanie Lyden ◽  
Jennifer Majersik
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Blood Pressure Control ◽  
Primary Outcome ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Blood Pressure Reduction ◽  
Pressure Control ◽  
Significant Difference ◽  
History Of

Background: The Systolic Blood Pressure Intervention Trial enrolled patients aged 50 or older with at least one cardiovascular disease risk factor, but free of prior symptomatic stroke. Patients were assigned to two blood pressure reduction goals (<140 versus 120 mm Hg). There was not a significant difference in the rate of stroke, making this an ideal cohort to refine risk prediction of primary stroke, which is understudied in patients with adequate blood pressure control and a rigorously adjudicated outcome of stroke. Methods: The primary outcome is ischemic stroke. We fit Cox models to the primary outcome and evaluated all baseline demographic variables to determine which would be most predictive of stroke, which we then used to create a prediction score. Results: We included 9,361 patients with a mean (SD) age of 67.9 (9.4) years and 171 (1.8%) patients met the primary outcome of stroke. For our prediction model, we gave one point each for history of TIA, atrial fibrillation, congestive heart failure, or diabetes. Patients with 2 or more points were collapsed, making three possible scores of 0, 1, and 2, which had rates of stroke of 1.5% (117/8042), 3.2% (30/933), and 6.2% (24/386) (p<0.001). Compared to a score of 0, the hazard ratios for stroke of score 1 and 2 were 2.3 (95% CI, 1.6-3.5) and 4.6 (95% CI, 2.9-7.1) (both p<0.001) (Figure 1). Conclusion: A simple scoring system can improve prediction of ischemic stroke from 1.8% to 6.2% in patients with no prior history of stroke and excellent blood pressure control. This information could be used to improve patient selection for clinical trials or for identifying patients for more aggressive primary prevention strategies.

scholarly journals Optimal blood pressure after reperfusion therapy in patients with acute ischemic stroke

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Kang-Ho Choi ◽  
Jae-Myung Kim ◽  
Ja-Hae Kim ◽  
Joon-Tae Kim ◽  
Man-Seok Park ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Reperfusion Therapy ◽  
Optimal Blood Pressure

Intensive blood pressure control may not be safe in subacute ischemic stroke by intracranial atherosclerosis

2018 ◽  
Vol 36 (9) ◽  
pp. 1936-1941 ◽  
Author(s):  
Jong-Moo Park ◽  
Bum Joon Kim ◽  
Sun U. Kwon ◽  
Yang-Ha Hwang ◽  
Sung Hyuk Heo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Blood Pressure Control ◽  
Pressure Control ◽  
Intracranial Atherosclerosis ◽  
Intensive Blood Pressure

Survey of blood pressure control status in patients with ischemic stroke or transient ischemic attack in China

2008 ◽  
Vol 30 (4) ◽  
pp. 348-355 ◽  
Author(s):  
Yilong Wang ◽  
Di Wu ◽  
Yong Zhou ◽  
Xingquan Zhao ◽  
Chunxue Wang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Blood Pressure Control ◽  
Transient Ischemic Attack ◽  
Pressure Control ◽  
Ischemic Attack

scholarly journals Hemorrhagic Transformation After Ischemic Stroke: Mechanisms and Management

2021 ◽  
Vol 12 ◽  
Author(s):  
Ji Man Hong ◽  
Da Sol Kim ◽  
Min Kim
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Pressure Control ◽  
Reperfusion Therapy ◽  
Hemorrhagic Transformation ◽  
Biological Research ◽  
Related Factors ◽  
Natural Progression ◽  
Promising Therapeutic Approach ◽  
Radiological Images

Symptomatic hemorrhagic transformation (HT) is one of the complications most likely to lead to death in patients with acute ischemic stroke. HT after acute ischemic stroke is diagnosed when certain areas of cerebral infarction appear as cerebral hemorrhage on radiological images. Its mechanisms are usually explained by disruption of the blood-brain barrier and reperfusion injury that causes leakage of peripheral blood cells. In ischemic infarction, HT may be a natural progression of acute ischemic stroke and can be facilitated or enhanced by reperfusion therapy. Therefore, to balance risks and benefits, HT occurrence in acute stroke settings is an important factor to be considered by physicians to determine whether recanalization therapy should be performed. This review aims to illustrate the pathophysiological mechanisms of HT, outline most HT-related factors after reperfusion therapy, and describe prevention strategies for the occurrence and enlargement of HT, such as blood pressure control. Finally, we propose a promising therapeutic approach based on biological research studies that would help clinicians treat such catastrophic complications.

scholarly journals Effect of Intensive Versus Standard Blood Pressure Control on Stroke Subtypes

Hypertension ◽  
2021 ◽  
Vol 77 (4) ◽  
pp. 1391-1398
Author(s):  
Clinton B. Wright ◽  
Alexander P. Auchus ◽  
Alan Lerner ◽  
Walter T. Ambrosius ◽  
Hakan Ay ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Blood Pressure Control ◽  
Standard Treatment ◽  
Pressure Control ◽  
Intensive Treatment ◽  
Large Artery ◽  
Stroke Subtypes ◽  
Small Artery Occlusion ◽  
Blood Pressures

In the SPRINT (Systolic Blood Pressure Intervention Trial), the number of strokes did not differ significantly by treatment group. However, stroke subtypes have heterogeneous causes that could respond differently to intensive blood pressure control. SPRINT participants (N=9361) were randomized to target systolic blood pressures of <120 mm Hg (intensive treatment) compared with <140 mm Hg (standard treatment). We compared incident hemorrhage, cardiac embolism, large- and small-vessel infarctions across treatment arms. Participants randomized to the intensive arm had mean systolic blood pressures of 121.4 mm Hg in the intensive arm (N=4678) and 136.2 mm Hg in the standard arm (N=4683) at one year. Sixty-nine strokes occurred in the intensive arm and 78 in the standard arm when SPRINT was stopped. The breakdown of stroke subtypes across treatment arms included hemorrhagic (intensive treatment, n=6, standard treatment, n=7) and ischemic stroke subtypes (large artery atherosclerosis: intensive treatment n=11, standard treatment, n=13; cardiac embolism: intensive treatment n=11, standard treatment n=15; small artery occlusion: intensive treatment n=8, standard treatment n=8; other ischemic stroke: intensive treatment n=3, standard treatment n=1). Fewer strokes occurred among participants without prior cardiovascular disease in the intensive (n=43) than the standard arm (n=61), but the difference did not reach predefined statistical significance level of 0.05 ( P =0.09). The interaction between baseline cardiovascular risk factor status and treatment arm on stroke risk did not reach significance ( P =0.05). Similar numbers of stroke subtypes occurred in the intensive BP control and standard control arms of SPRINT.

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