#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Is spontaneous normalization of systolic blood pressure within 24 hours after ischemic stroke onset related with favorable outcomes?


Autoři: Seo Hyun Kim aff001;  Ji In Kim aff001;  Ji-Yong Lee aff001;  Chan Ik Park aff001;  Jin Yong Hong aff001;  Sung-Soo Lee aff001
Působiště autorů: Department of Neurology, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do, Republic of Korea aff001
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0224293

Souhrn

Background

In acute ischemic stroke, blood pressure (BP) tends to rise initially and fall to a baseline level within 24–48 hours. Previous studies reported several different effects of BPs during acute ischemic stroke on clinical outcomes, which was partly due to the different time intervals from stroke onset to BP measurement.

Methods

All patients with acute ischemic stroke (onset ≤3 hours) who lived independently before the stroke, were consecutively enrolled for a 62-month period. BPs at 0, 12, and 24 hours after admission were collected. A favorable outcome was defined as a modified Rankin Scale (mRS) score 0–2 at discharge. For different standards of BP management, patients were grouped and analyzed according to intravenous (IV) tissue plasminogen activator (tPA) treatment and favorable outcome.

Results

Among the 446 enrolled patients, 227 patients underwent IV tPA treatment and 216 had mRS score 0–2 at discharge. Patients with favorable outcomes had lower initial NIH Stroke Scale (NIHSS) scores, less frequent progressive neurological deficits, and lower systolic BP (SBP) 12 and 24 hours after admission than patients with unfavorable outcomes, regardless of whether they underwent tPA treatment or not (p <0.05). The BP decreased over a period of 24 hours after admission. In logistic regression analysis, the independent variables associated with favorable outcome were the initial NIHSS score, a progressive neurological deficit, a previous stroke, and the SBP 24 hours after admission in the patients who underwent tPA treatment and the initial NIHSS score and a progressive neurological deficit in the patients who did not undergo tPA treatment (p <0.05).

Conclusions

The SBPs at 12 and 24 hours after admission were lower in acute stroke patients with favorable outcomes than in the other patients, regardless of whether the patients underwent tPA therapy and the SBP at 24 hours was an independent predictor of favorable outcomes among the patients who underwent tPA treatment.

Klíčová slova:

stroke – Ischemic stroke – Hemorrhagic stroke – Blood pressure – Hypertension – Antihypertensives – Regression analysis – Atrial fibrillation


Zdroje

1. Hall JE, Granger JP, Jones DW, Hall ME. Pathophysiology of Hypertension. In: Fuster V, Harrington RA, Narula J, Eapen ZJ, editors. Hurst's the heart, 14e. New York, NY: McGraw-Hill Education; 2017.

2. Qureshi AI. Acute hypertensive response in patients with stroke: pathophysiology and management. Circulation. 2008; 118: 176–187. doi: 10.1161/CIRCULATIONAHA.107.723874 18606927

3. Kakaletsis N, Ntaios G, Milionis H, Haidich AB, Makaritsis K, Savopoulos C, et al. Prognostic value of 24-h ABPM in acute ischemic stroke for short-, medium-, and long-term outcome: a systematic review and meta-analysis. Int J Stroke. 2015; 10: 1000–1007. doi: 10.1111/ijs.12609 26283262

4. Ji N, Meng P, Liu N, Xu B, Zhang G, Zhou X, et al. A reasonable blood pressure level for good clinical outcome after the acute phase of ischemic stroke. J Clin Hypertens. 2016; 18: 536–542.

5. Wu W, Huo X, Zhao X, Liao X, Wang C, Pan Y, et al. Relationship between Blood Pressure and Outcomes in Acute Ischemic Stroke Patients Administered Lytic Medication in the TIMS-China Study. PLoS One. 2016; 11: e0144260. doi: 10.1371/journal.pone.0144260 26828609

6. Kvistad CE, Logallo N, Oygarden H, Thomassen L, Waje-Andreassen U, Naess H. Elevated admission blood pressure and stroke severity in acute ischemic stroke: the Bergen NORSTROKE Study. Cerebrovasc Dis. 2013; 36: 351–354. doi: 10.1159/000355685 24192488

7. Kim SH, Lee JY, Kim DH, Ham JH, Song YK, Lim EJ, et al. Factors related to the initial stroke severity of posterior circulation ischemic stroke. Cerebrovasc Dis. 2013; 36: 62–68. doi: 10.1159/000351512 23921172

8. Adams HP, del Zoppo G, Alberts MJ, Bhatt DL, Brass L, Furlan A, et al. Guidelines for the early management of adults with ischemic stroke. Stroke. 2007;38:1655–1711. doi: 10.1161/STROKEAHA.107.181486 17431204

9. Adams HP Jr., Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993; 24: 35–41. doi: 10.1161/01.str.24.1.35 7678184

10. LR C. Posterior Circulation Disease: Clinical findings. Cambridge: Blackwell Science; 1996.

11. Sykora M, Diedler J, Turcani P, Hacke W, Steiner T. Baroreflex: a new therapeutic target in human stroke? Stroke. 2009; 40: e678–e682. doi: 10.1161/STROKEAHA.109.565838 19834010

12. McManus M, Liebeskind DS. Blood Pressure in Acute Ischemic Stroke. J Clin Neurol. 2016;12:137–146. doi: 10.3988/jcn.2016.12.2.137 26833984

13. Martins AI, Sargento-Freitas J, Silva F, Jesus-Ribeiro J, Correia I, Gomes JP, et al. Recanalization modulates association between blood pressure and functional outcome in acute ischemic stroke. Stroke. 2016;47:1571–1576. doi: 10.1161/STROKEAHA.115.012544 27118796

14. John S, Hazaa W, Uchino K, Hussain MS. Timeline of blood pressure changes after intra-arterial therapy for acute ischemic stroke based on recanalization status. J Neurointerv Surg. 2017; 9: 455–458. doi: 10.1136/neurintsurg-2016-012369 27084964

15. Maier IL, Tsogkas I, Behme D, Bahr M, Knauth M, Psychogios MN, et al. High systolic blood pressure after successful endovascular treatment affects early functional outcome in acute ischemic stroke. Cerebrovasc Dis. 2018;45:18–25. doi: 10.1159/000484720 29176326

16. Christou I, Alexandrov AV, Burgin WS, Wojner AW, Felberg RA, Malkoff M, et al. Timing of recanalization after tissue plasminogen activator therapy determined by transcranial Doppler correlates with clinical recovery from ischemic stroke. Stroke. 2000; 31: 1812–1816. doi: 10.1161/01.str.31.8.1812 10926939

17. Kraemer N, Thomalla G, Soennichsen J, Fiehler J, Knab R, Kucinski T, et al. Magnetic resonance imaging and clinical patterns of patients with 'spectacular shrinking deficit' after acute middle cerebral artery stroke. Cerebrovasc Dis. 2005; 20: 285–290. doi: 10.1159/000087926 16131796

18. Manning LS, Rothwell PM, Potter JF, Robinson TG. Prognostic significance of short-term blood pressure variability in acute stroke: systematic review. Stroke. 2015;46:2482–2490. doi: 10.1161/STROKEAHA.115.010075 26243226

19. Chouchou F, Pichot V, Pepin JL, Tamisier R, Celle S, Maudoux D, et al. Sympathetic overactivity due to sleep fragmentation is associated with elevated diurnal systolic blood pressure in healthy elderly subjects: the PROOF-SYNAPSE study. Eur Heart J. 2013;34:2122–2131. doi: 10.1093/eurheartj/eht208 23756334

20. Bloomfield DA, Park A. Decoding white coat hypertension. World J Clin Cases. 2017; 5: 82–92. doi: 10.12998/wjcc.v5.i3.82 28352632

21. Gioia LC, Zewude RT, Kate MP, Liss K, Rowe BH, Buck B, et al. Prehospital systolic blood pressure is higher in acute stroke compared with stroke mimics. Neurology. 2016; 86: 2146–2153. doi: 10.1212/WNL.0000000000002747 27194383

22. Kim BJ, Cho YJ, Hong KS, Lee J, Kim JT, Choi KH, et al. Trajectory groups of 24-hour systolic blood pressure after acute ischemic stroke and recurrent vascular events. Stroke. 2018;49:1835–1842.

23. Adams HP Jr., Davis PH, Leira EC, Chang KC, Bendixen BH, Clarke WR, et al. Baseline NIH Stroke Scale score strongly predicts outcome after stroke: A report of the Trial of Org 10172 in Acute Stroke Treatment (TOAST). Neurology. 1999; 53: 126–131. doi: 10.1212/wnl.53.1.126 10408548

24. Geng HH, Wang Q, Li B, Cui BB, Jin YP, Fu RL, et al. Early neurological deterioration during the acute phase as a predictor of long-term outcome after first-ever ischemic stroke. Medicine. 2017; 96: e9068. doi: 10.1097/MD.0000000000009068 29390435

25. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Hacke W, Kaste M, Fieschi C, von Kummer R, Davalos A, Meier D, et al. Lancet. 1998;352:1245–1251. doi: 10.1016/s0140-6736(98)08020-9 9788453

26. Fujita K, Komatsu Y, Sato N, Higuchi O, Kujiraoka Y, Kamezaki T, et al. Pilot study of the safety of starting administration of low-dose aspirin and cilostazol in acute ischemic stroke. Neurol Med Chir. 2011;51:819–824.

27. Dharmasaroja PA, Muengtaweepongsa S, Dharmasaroja P. Early outcome after intravenous thrombolysis in patients with acute ischemic stroke. Neurol India. 2011;59:351–354. doi: 10.4103/0028-3886.82723 21743161

28. Bath PMW, Krishnan K. Interventions for deliberately altering blood pressure in acute stroke. Cochrane Database Syst Rev. 2014. doi: 10.1002/14651858.CD000039.pub3 25353321

29. Ovbiagele B, Saver JL. Day-90 acute ischemic stroke outcomes can be derived from early functional activity level. Cerebrovasc Dis. 2010; 29: 50–56. doi: 10.1159/000255974 19893312


Článok vyšiel v časopise

PLOS One


2019 Číslo 10
Najčítanejšie tento týždeň
Najčítanejšie v tomto čísle
Kurzy

Zvýšte si kvalifikáciu online z pohodlia domova

Získaná hemofilie - Povědomí o nemoci a její diagnostika
nový kurz

Eozinofilní granulomatóza s polyangiitidou
Autori: doc. MUDr. Martina Doubková, Ph.D.

Všetky kurzy
Prihlásenie
Zabudnuté heslo

Zadajte e-mailovú adresu, s ktorou ste vytvárali účet. Budú Vám na ňu zasielané informácie k nastaveniu nového hesla.

Prihlásenie

Nemáte účet?  Registrujte sa

#ADS_BOTTOM_SCRIPTS#