Are we ever going to get a blood pressure protocol? Or will we wait until stroke survivors are in charge? This question has been out there forever. Is your doctor and stroke hospital sitting on their asses WAITING FOR SOMEONE ELSE TO SOLVE THE PROBLEM?
Systolic Blood Pressure Control and Mortality After Stroke in Hypertensive Patients July 2015
BP Lowering in Acute Stroke Flops for Improving Outcomes February 2015
After stroke, compared with Systolic Blood Pressure in the high range, low to normal SBP is associated with poorer mortality outcomes. May 2015
Systolic Blood Pressure and Mortality After Stroke May 2015
Blood pressure-lowering treatment with candesartan had no beneficial effect on activities of daily living and level of care at 6 months June 2015
Blood pressure reduction in acute ischemic stroke according to time to treatment: a subgroup analysis of the China Antihypertensive Trial in Acute Ischemic Stroke trial May 2017
Intensive blood pressure lowering in patients with acute intracerebral haemorrhage: Clinical outcomes and haemorrhage expansion. Systematic review and meta-analysis of randomised trials February 2017
But this to think about:
Don't go too low with blood pressure in hypertensive CAD patients
The latest here:
Effects of Blood Pressure in the Early Phase of Ischemic Stroke and Stroke Subtype on Poststroke Cognitive Impairment
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Abstract
Background and Purpose—Blood pressure (BP) control in the early phase of stroke is controversial to reduce the risk of poststroke cognitive impairment (PSCI). This study was to investigate the impact of BP levels in the early phase of ischemic stroke and stroke subtype on PSCI.
Methods—Seven hundred and ninety-six patients with acute ischemic stroke were included. Cognitive function was assessed after stroke onset using the Montreal Cognitive Assessment. Patients were divided into quintiles according to systolic BP and diastolic BP levels in the early phase. Subtype analyses were according to Trial of ORG 10172 in Acute Stroke Treatment classification (infarct cause) and Oxfordshire Community Stroke Project classification (infarct location).
Results—After adjusting for multiple variables, the quintiles with the lowest systolic BP (Q1, 102–127 mm Hg) and with the highest systolic BP (Q5, 171–215 mm Hg) were associated with increased PSCI risk (odds ratio, 1.83; 95% confidence interval, 1.64–2.28; P=0.007 in Q1; odds ratio, 2.32; 95% confidence interval, 1.74–2.90; P<0.001 in Q5) at 3 months as compared with the middle quintile (Q3, 143–158 mm Hg). Similar association was found in diastolic BP quintiles. The analysis of cerebral infarction subtype demonstrated that both large artery atherosclerosis and total anterior circulation infarct were associated with increased risk of PSCI at 3 months after adjusting for multiple variables (large artery atherosclerosis: odds ratio, 1.42; 95% confidence interval, 1.06–1.90; P=0.031; total anterior circulation infarct: odds ratio, 1.68; 95% confidence interval, 1.32–2.15; P=0.001).
Conclusions—Lower or higher BP in the early phase of ischemic stroke was correlated with increased PSCI risk at 3 months. Maintaining systolic/diastolic BP in the levels of 143 to 158/93 to 102 mm Hg might be beneficial to reduce the occurrence of PSCI. Moreover, large artery atherosclerosis subtype and total anterior circulation infarct subtype were correlated with increased PSCI risk at 3 months.
Clinical Trial Registration—URL: https://www.chictr.org. Unique identifier: ChiCTR-TRC-14004804.
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