This Article Full Text Full Text (PDF) 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 Chamorro, A. Articles by Blanc, R. Search for Related Content PubMed PubMed Citation Articles by Chamorro, A. Articles by Blanc, R.

(Stroke. 1998;29:1850-1853.)
© 1998 American Heart Association, Inc.

Original Contributions

Blood Pressure and Functional Recovery in Acute Ischemic Stroke

A. Chamorro, MD; N. Vila, MD; C. Ascaso, PhD; E. Elices, MD; W. Schonewille, MD; R. Blanc, MD

From the Neurology Service/IDIBAPS (A.C., N.V., E.E., W.S., R.B.) and Department of Epidemiology and Biostatistics (C.A.), Hospital Clínic, Barcelona, Spain.

Correspondence to Angel Chamorro, MD, Neurology Service, Hospital Clínic, 170 Villarroel, 08036 Barcelona, Spain. E-mail chamorro{at}medicina.ub.es

Background and Purpose—The relevance of elevated blood pressure in acute ischemic stroke and its most appropriate management are unresolved. We aimed to evaluate the rate of functional recovery with relation to early blood pressure management in patients with ischemic stroke.

Methods—Four hundred eighty-one consecutive ischemic stroke patients were admitted to the Neurology Service within 20.9±10.5 hours of symptoms onset as part of the Barcelona Downtown Stroke Registry, including 235 patients who received oral antihypertensive agents within <24 hours after stroke onset. Demographic, clinical (Mathew scale), and CT scan findings were collected prospectively. Mean arterial pressure (MAP) was recorded before hospital arrival and at 7 AM on days 1, 2, and 7 of hospitalization. The primary end point was complete functional recovery at day 7 defined as a score of 0 to 1 on the modified Rankin scale.

Results—Two hundred fifty-two patients achieved complete recovery on day 7. Using logistic regression, independent predictors of complete recovery included mild impairment at stroke presentation, lack of history of hypertension, and absence of brain edema on CT scan. Also, a 20% to 30% drop in MAP on day 2 after stroke onset almost tripled the odds of full recovery (odds ratio, 2.9; 95% CI, 1.3 to 6.3). MAP tended to normalize after stroke in all subjects, more rapidly if hypotensive agents were administered. Brain edema was also less frequent in patients with a greater drop in blood pressure. Despite the fact that a drop in MAP >30% from baseline was observed in 49 patients, this preceded worsening stroke in only 4 patients. Conversely, worsening stroke occurred in 51 patients despite stable blood pressure.

Conclusions—These results suggest that complete recovery in ischemic stroke is facilitated by a moderate blood pressure reduction when brain edema develops, most likely as the result of a more adequate cerebral perfusion pressure. Conversely, stroke worsening due to pharmacological hypoperfusion is exceptional.

Key Words: cerebrovascular disorders • blood pressure • stroke therapy

This article has been cited by other articles:

				R. Leira, M. Millan, E. Diez-Tejedor, M. Blanco, J. Serena, B. Fuentes, M. Rodriguez-Yanez, M. Castellanos, A. Lago, A. Davalos, et al. Age Determines the Effects of Blood Pressure Lowering During the Acute Phase of Ischemic Stroke: The TICA Study Hypertension, October 1, 2009; 54(4): 769 - 774. [Abstract] [Full Text] [PDF]

				N. Ahmed, N. Wahlgren, M. Brainin, J. Castillo, G. A. Ford, M. Kaste, K. R. Lees, D. Toni, and for the SITS Investigators Relationship of Blood Pressure, Antihypertensive Therapy, and Outcome in Ischemic Stroke Treated With Intravenous Thrombolysis: Retrospective Analysis From Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register (SITS-ISTR) Stroke, July 1, 2009; 40(7): 2442 - 2449. [Abstract] [Full Text] [PDF]

				M. A. Ritter, P. Kimmeyer, P. U. Heuschmann, R. Dziewas, R. Dittrich, D. G. Nabavi, and E. B. Ringelstein Blood Pressure Threshold Violations in the First 24 Hours After Admission for Acute Stroke: Frequency, Timing, Predictors, and Impact on Clinical Outcome Stroke, February 1, 2009; 40(2): 462 - 468. [Abstract] [Full Text] [PDF]

				M. Yong and M. Kaste Association of Characteristics of Blood Pressure Profiles and Stroke Outcomes in the ECASS-II Trial Stroke, February 1, 2008; 39(2): 366 - 372. [Abstract] [Full Text] [PDF]

				M. Rodriguez-Yanez, M. Castellanos, M. Blanco, M. M. Garcia, F. Nombela, J. Serena, R. Leira, I. Lizasoain, A. Davalos, and J. Castillo New-onset hypertension and inflammatory response/poor outcome in acute ischemic stroke Neurology, December 12, 2006; 67(11): 1973 - 1978. [Abstract] [Full Text] [PDF]

				E. Ruttmann, J. Willeit, H. Ulmer, O. Chevtchik, D. Hofer, W. Poewe, G. Laufer, and L. C. Muller Neurological Outcome of Septic Cardioembolic Stroke After Infective Endocarditis Stroke, August 1, 2006; 37(8): 2094 - 2099. [Abstract] [Full Text] [PDF]

				D. A. Grant, C. Franzini, J. Wild, K. J. Eede, and A. M. Walker Autoregulation of the cerebral circulation during sleep in newborn lambs J. Physiol., May 1, 2005; 564(3): 923 - 930. [Abstract] [Full Text] [PDF]

				H. P. Mattle, L. Kappeler, M. Arnold, U. Fischer, K. Nedeltchev, L. Remonda, S. M. Jakob, and G. Schroth Blood Pressure and Vessel Recanalization in the First Hours After Ischemic Stroke Stroke, February 1, 2005; 36(2): 264 - 268. [Abstract] [Full Text] [PDF]

				P. J. Lindsberg Editorial Comment--High Blood Pressure After Acute Cerebrovascular Occlusion: Risk or Risk Marker? Stroke, February 1, 2005; 36(2): 268 - 269. [Full Text] [PDF]

				J.K. McGill, L. Gallagher, H.V.O. Carswell, E.A. Irving, A.F. Dominiczak, and I.M. Macrae Impaired Functional Recovery After Stroke in the Stroke-Prone Spontaneously Hypertensive Rat Stroke, January 1, 2005; 36(1): 135 - 141. [Abstract] [Full Text] [PDF]

				G. Boysen Editorial Comment--Persisting Dilemma: To Treat or Not to Treat Blood Pressure in Acute Ischemic Stroke Stroke, February 1, 2004; 35(2): 526 - 527. [Full Text] [PDF]

				J. Castillo, R. Leira, M. M. Garcia, J. Serena, M. Blanco, and A. Davalos Blood Pressure Decrease During the Acute Phase of Ischemic Stroke Is Associated With Brain Injury and Poor Stroke Outcome Stroke, February 1, 2004; 35(2): 520 - 526. [Abstract] [Full Text] [PDF]

				L. B. Goldstein Blood Pressure Management in Patients With Acute Ischemic Stroke Hypertension, February 1, 2004; 43(2): 137 - 141. [Full Text] [PDF]

				M. Willmot, J. Leonardi-Bee, and P. M.W. Bath High Blood Pressure in Acute Stroke and Subsequent Outcome: A Systematic Review Hypertension, January 1, 2004; 43(1): 18 - 24. [Abstract] [Full Text] [PDF]

				A. Semplicini, A. Maresca, G. Boscolo, M. Sartori, R. Rocchi, V. Giantin, P. L. Forte, and A. C. Pessina Hypertension in Acute Ischemic Stroke: A Compensatory Mechanism or an Additional Damaging Factor? Arch Intern Med, January 27, 2003; 163(2): 211 - 216. [Abstract] [Full Text] [PDF]

				N. Ahmed, P. Nasman, and N. G. Wahlgren Effect of Intravenous Nimodipine on Blood Pressure and Outcome After Acute Stroke Stroke, June 1, 2000; 31(6): 1250 - 1255. [Abstract] [Full Text] [PDF]

				S. L. Dawson, B. N. Manktelow, T. G. Robinson, R. B. Panerai, and J. F. Potter Which Parameters of Beat-to-Beat Blood Pressure and Variability Best Predict Early Outcome After Acute Ischemic Stroke? Stroke, February 1, 2000; 31(2): 463 - 468. [Abstract] [Full Text] [PDF]

				C. Bassetti and M. Aldrich Night time versus daytime transient ischaemic attack and ischaemic stroke: a prospective study of 110 patients J. Neurol. Neurosurg. Psychiatry, October 1, 1999; 67(4): 463 - 467. [Abstract] [Full Text] [PDF]