Blood Pressures Immediately Following Ischemic Strokes Are Associated with Cerebral Perfusion and Neurologic Function

Overview

Journal J Clin Hypertens (Greenwich)

Specialty Cardiology & Vascular Diseases

Date 2018 May 26

PMID 29797394

Citations 5

Authors

MingLi He

Bing Cui

Cunjin Wu

Pin Meng

Taotao Wu

Mingyu Wang

Ru Yang

Lin Zhou

Xiaobin He

Bingchao Xu

Zaipo Li

Bei Xu

Zenglin Cai

Yongan Sun

Rutai Hui

Yibo Wang

Affiliations

Soon will be listed here.

Abstract

The optimal range of blood pressure levels in the early phase of ischemic stroke with hypertension is still controversial. Based on our stroke registry database, we explored the relationship between blood pressure levels and cerebral perfusion in the early phase of ischemic stroke with hypertension and neurofunctional recovery at 3 months after stroke. Total 732 stroke patients with hypertension were finally analyzed. Patients were divided into quintiles according to systolic blood pressure (SBP) and diastolic blood pressure (DBP) to perform multivariable logistic regression to analyze their relation with neurofunctional recovery, respectively. The cerebral perfusion levels displayed a reverse "U" shape curve with the change of blood pressure levels. Sufficient estimated cerebral blood flow (ECBF) in the early phase of ischemic stroke was associated with good neurofunctional recovery at 3 months after stroke. The best neurofunctional recovery was observed in the middle quintiles with SBP at 161 to 177 mm Hg and DBP at 103 to 114 mm Hg, respectively. So maintaining appropriate blood pressure levels in the early phase of ischemic stroke might be beneficial to cerebral perfusion and neurofunctional recovery.

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Blood pressures immediately following ischemic strokes are associated with cerebral perfusion and neurologic function.

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References

Ishitsuka K, Kamouchi M, Hata J, Fukuda K, Matsuo R, Kuroda J . High blood pressure after acute ischemic stroke is associated with poor clinical outcomes: Fukuoka Stroke Registry. Hypertension. 2013; 63(1):54-60. DOI: 10.1161/HYPERTENSIONAHA.113.02189. View

Robinson T, Potter J, Ford G, Bulpitt C, Chernova J, Jagger C . Effects of antihypertensive treatment after acute stroke in the Continue or Stop Post-Stroke Antihypertensives Collaborative Study (COSSACS): a prospective, randomised, open, blinded-endpoint trial. Lancet Neurol. 2010; 9(8):767-75. DOI: 10.1016/S1474-4422(10)70163-0. View

Jordan J, Powers W . Cerebral autoregulation and acute ischemic stroke. Am J Hypertens. 2012; 25(9):946-50. DOI: 10.1038/ajh.2012.53. View

Semplicini A, Maresca A, Boscolo G, Sartori M, Rocchi R, Giantin V . Hypertension in acute ischemic stroke: a compensatory mechanism or an additional damaging factor?. Arch Intern Med. 2003; 163(2):211-6. DOI: 10.1001/archinte.163.2.211. View

Damm K, Gerhardt T, Marschall F, MALORNY G . [Level of blood sugar in rabbits investigated under atmospheric pressure and high pressure after acute carbon monoxide intoxication]. Arch Toxikol. 1972; 29(2):159-70. View

Ricci S, Diciotti S, Francalanci L, Tortoli P . Accuracy and reproducibility of a novel dual-beam vector Doppler method. Ultrasound Med Biol. 2008; 35(5):829-38. DOI: 10.1016/j.ultrasmedbio.2008.10.012. View

Lyakishev A . [Efficacy of Nitric Oxide, With or Without Continuing Antihypertensive Treatment, for Management of High Blood Pressure in Acute Stroke. Results of the ENOS study]. Kardiologiia. 2015; 55(5):78-9. DOI: 10.18565/cardio.2015.5.78-79. View

He J, Zhang Y, Xu T, Zhao Q, Wang D, Chen C . Effects of immediate blood pressure reduction on death and major disability in patients with acute ischemic stroke: the CATIS randomized clinical trial. JAMA. 2013; 311(5):479-89. DOI: 10.1001/jama.2013.282543. View

Tortoli P, Dallai A, Boni E, Francalanci L, Ricci S . An automatic angle tracking procedure for feasible vector Doppler blood velocity measurements. Ultrasound Med Biol. 2010; 36(3):488-96. DOI: 10.1016/j.ultrasmedbio.2009.11.004. View

10.

Sandset E, Bath P, Boysen G, Jatuzis D, Korv J, Luders S . The angiotensin-receptor blocker candesartan for treatment of acute stroke (SCAST): a randomised, placebo-controlled, double-blind trial. Lancet. 2011; 377(9767):741-50. DOI: 10.1016/S0140-6736(11)60104-9. View

11.

Ntaios G, Bath P, Michel P . Blood pressure treatment in acute ischemic stroke: a review of studies and recommendations. Curr Opin Neurol. 2009; 23(1):46-52. DOI: 10.1097/WCO.0b013e3283355694. View

12.

Novak V, Hu K, DesRochers L, Novak P, Caplan L, Lipsitz L . Cerebral flow velocities during daily activities depend on blood pressure in patients with chronic ischemic infarctions. Stroke. 2009; 41(1):61-6. PMC: 2811046. DOI: 10.1161/STROKEAHA.109.565556. View

13.

Cumbler E, Glasheen J . Management of blood pressure after acute ischemic stroke: An evidence-based guide for the hospitalist. J Hosp Med. 2007; 2(4):261-7. DOI: 10.1002/jhm.165. View

14.

Wang Y, Wang J, Meng P, Liu N, Ji N, Zhang G . Mid-Term Blood Pressure Variability Is Associated With Clinical Outcome After Ischemic Stroke. Am J Hypertens. 2017; 30(10):968-977. DOI: 10.1093/ajh/hpx083. View

15.

Guo Z, Liu J, Xing Y, Yan S, Lv C, Jin H . Dynamic cerebral autoregulation is heterogeneous in different subtypes of acute ischemic stroke. PLoS One. 2014; 9(3):e93213. PMC: 3966889. DOI: 10.1371/journal.pone.0093213. View

16.

Osaki Y, Matsubayashi K, Yamasaki M, Okumiya K, Yoshimura K, Hamashige N . Post-stroke hypertension correlates with neurologic recovery in patients with acute ischemic stroke. Hypertens Res. 1998; 21(3):169-73. DOI: 10.1291/hypres.21.169. View

17.

Wu X, Wang C, Zhang Z, Fu Y, Liu F, Liu X . Puerarin attenuates cerebral damage by improving cerebral microcirculation in spontaneously hypertensive rats. Evid Based Complement Alternat Med. 2014; 2014:408501. PMC: 3971448. DOI: 10.1155/2014/408501. View

18.

Jorgensen H, Nakayama H, Raaschou H, Olsen T . Effect of blood pressure and diabetes on stroke in progression. Lancet. 1994; 344(8916):156-9. DOI: 10.1016/s0140-6736(94)92757-x. View

19.

Saver J . Blood pressure management in early ischemic stroke. JAMA. 2014; 311(5):469-70. DOI: 10.1001/jama.2013.282544. View

20.

He M, Cui B, Wu C, Meng P, Wu T, Wang M . Blood pressures immediately following ischemic strokes are associated with cerebral perfusion and neurologic function. J Clin Hypertens (Greenwich). 2018; 20(6):1008-1015. PMC: 8030829. DOI: 10.1111/jch.13310. View