This Article Full Text Full Text (PDF) All Versions of this Article: 37/6/1565    most recent 01.STR.0000222002.57530.05v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Mistri, A. K. Articles by Potter, J. F. Search for Related Content PubMed PubMed Citation Articles by Mistri, A. K. Articles by Potter, J. F. Related Collections Other Stroke Treatment - Medical Acute Cerebral Infarction Emergency treatment of Stroke

(Stroke. 2006;37:1565.)
© 2006 American Heart Association, Inc.

Comments, Opinions, and Reviews

Pressor Therapy in Acute Ischemic Stroke

Systematic Review

From the University of Leicester; and the Leicester Warwick Medical School, Ageing and Stroke Medicine, University Department of Cardiovascular Sciences, The Glenfield Hospital, Leicester, UK.

Correspondence to Dr A. Mistri, Clinical Research Fellow, Ageing and Stroke Medicine, University Department of Cardiovascular Sciences, The Glenfield Hospital, Groby Road, Leicester LE3 9QP. E-mail chhips{at}le.ac.uk

Background and Purpose— Systolic blood pressure (SBP) levels below 140 mm Hg after acute stroke occur in 18% to 25% of patients, and may be associated with adverse outcome, in terms of death and disability. It has thus been proposed that BP elevation in acute ischemic stroke may be beneficial by increasing perfusion to the peri-infarct penumbra, though not only in those with low BP levels.

Methods— All articles studying BP elevation in the context of acute stroke were identified using a structured search strategy.

Results— Two reviewers independently searched the databases, and 12 relevant publications were identified. All identified publications related to acute ischemic stroke and no articles on pressor therapy in primary hemorrhagic stroke were found. The review included 319 subjects (age: 42 to 88 years, 46% male), with phenylephrine being the most commonly used pressor agent, though 8 studies incorporated volume expansion. Because of small numbers, and varying entry/outcome criteria, no meta-analysis of outcome measures was possible. Overall, in these few studies undertaken, pressor therapy in acute stroke appears feasible and well-tolerated. The benefit and risks in terms of clinical outcomes remains unknown, but intensive monitoring is advised if such therapy is undertaken.

Conclusions— Theoretical arguments exist for inducing BP elevation in acute ischemic stroke to increase blood flow to the ischemic penumbra across patients with a broad BP range. To date, there have only been a few small trials with inconclusive results. Many questions are still unanswered about the safety and potential benefits of pressor therapy in acute stroke. Hopefully, ongoing trials will answer some of these important questions.

Key Words: blood pressure • stroke, acute

This article has been cited by other articles:

				H. K. Shin, M. Nishimura, P. B. Jones, H. Ay, D. A. Boas, M. A. Moskowitz, and C. Ayata Mild Induced Hypertension Improves Blood Flow and Oxygen Metabolism in Transient Focal Cerebral Ischemia Stroke, May 1, 2008; 39(5): 1548 - 1555. [Abstract] [Full Text] [PDF]