Week 6: Management of Acute Stroke, part 4

#17: Blood pressure decrease during the acute phase of ischemic stroke is associated with brain injury and poor prognosis

  • This article is from 2004. I guess the merits of permissive hypertension was less settled then? They do suggest that hypertension could facilitate the development of edema in infarcted tissue so it kind of makes sense why people would be reluctant.
  • This paper followed 304 consecutive patients with hemispheric ischemic stroke who presented within 24 hours
  • Once in the stroke unit, patients were only treated for BP > 220/120, but a bunch of them already got meds in the ED, because, it’s the ED basically
  • Blood pressure on admission was not related to early neurologic deterioration or outcome at 3 months, but with some fancier statistics they managed to tease out a U-shaped curve: patients with SBP around 180 had the best outcomes
  • BP tended to decrease on its own within the first day
  • Reductions in SBP or DBP > 20mmHg were associated with increased infarct volume and overall worse outcomes

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Bottom line, I guess, is that super high blood pressure may be a marker of poor prognosis, but treating it is also harmful.

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