This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted 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 Google Scholar Google Scholar Articles by Lalouschek, W. Articles by Sandercock, P. A.G. Search for Related Content PubMed PubMed Citation Articles by Lalouschek, W. Articles by Sandercock, P. A.G.

(Stroke. 2002;33:2548.)
© 2002 American Heart Association, Inc.

Letters to the Editor

Blood Pressure and Clinical Outcome in Acute Ischemic Stroke

Wolfgang Lalouschek, MD Wilfried Lang, MD

Clinical Department of Clinical Neurology, University Clinic of Neurology, Vienna, Austria

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

We read with interest the recent report about the relationship between blood-pressure and clinical outcome in acute ischemic stroke.¹ On the basis of an analysis of a single blood pressure value before randomization in the IST trial, the authors found that high and low initial blood pressure values were associated with a worse clinical outcome. However, many of the patients, particularly those with high blood pressure values, were probably treated with antihypertensive agents in the acute phase. A relationship between a blood pressure drop within the first 24 hours after acute stroke and worse outcome in patients with acute ischemic stroke has recently been reported.² For a clinically relevant interpretation of the data from the IST trial, it is therefore crucial to differentiate whether high blood pressure levels themselves or, vice versa, the subsequent treatment with antihypertensive drugs in many of these patients, might have negatively influenced the outcome. The clinical consequences of these 2 hypotheses are completely opposite. We are concerned that many physicians will interpret the IST data as evidence to lower blood pressure levels in the acute phase if the systolic BP exceeds 150 mm Hg, which may be detrimental for their patients (in fact, we do not know). Such a misinterpretation is further promoted by the formulation of the authors that "patients with higher pressures might have a better outcome... if their blood pressure was actively lowered with an appropriate drug." However, the authors should have clearly noted that the opposite might also be true in . . . [Full Text of this Article]

Philip M.W. Bath, FRCP

Center for Vascular Research, University of Nottingham, Nottingham, UK

Stephen J. Phillips, FRCPC

Division of Neurology, Dalhousie University and Queen Elizabeth II Health Sciences Center, Halifax, Canada

Peter A.G. Sandercock, FRCP

Department of Clinical Neurosciences, Western General Hospitals, Edinburgh, UK