Blood pressure and stroke
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Summary
10 papers analyzed
These studies suggest that effective management and lowering of blood pressure significantly reduce the risk of stroke, stroke-related death, and disability, and improve outcomes in acute stroke patients.
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Blood Pressure and Stroke: Key Insights from Recent Research
High Blood Pressure in Acute Stroke and Outcomes
High blood pressure (BP) is frequently observed in patients experiencing an acute stroke and is associated with poor outcomes. A systematic review involving 10,892 patients found that elevated mean arterial BP (MABP) and high diastolic BP (DBP) significantly increased the odds of death (). Additionally, high systolic BP (SBP) and DBP were linked to combined death or dependency in primary intracerebral hemorrhage (PICH) and ischemic stroke (). These findings suggest that moderate BP lowering might improve outcomes, although this hypothesis requires testing in large, randomized trials ().
Blood Pressure Reduction and Stroke Risk
Lowering BP has been shown to significantly reduce the risk of stroke. A meta-analysis of over 40 randomized controlled trials, including more than 188,000 participants, indicated that a 10 mm Hg reduction in SBP is associated with a one-third reduction in stroke risk across various populations and age groups ( ). This benefit is consistent regardless of sex, region, or stroke subtype, and is observed in both fatal and nonfatal events ( ). The data emphasize the importance of initiating and maintaining BP reduction for stroke prevention.
Hypertension Management in Stroke Patients
Hypertension is the most prevalent risk factor for stroke, and its management is crucial for both primary and secondary prevention. Effective BP management can prevent the first episode of stroke and reduce the risk of recurrence ( ). Various antihypertensive agents, including angiotensin-converting enzyme inhibitors and diuretics, have been shown to reduce the risk of recurrent vascular events in patients with a history of stroke or transient ischemic attack (). However, the management of BP in stroke patients is complex and requires precise therapeutic goals due to the heterogeneous causes and hemodynamic consequences of stroke ().
Blood Pressure Control in Acute Stroke Treatment
The management of BP during the acute phase of stroke remains a topic of debate. A review of randomized controlled trials found that while certain antihypertensive drugs can lower BP, there is insufficient evidence to suggest that BP lowering during the acute phase improves functional outcomes (). It is generally recommended to withhold BP-lowering drugs until patients are medically and neurologically stable, after which treatment can be reintroduced ().
Blood Pressure and Stroke Thrombectomy Outcomes
In patients undergoing mechanical thrombectomy (MT) for acute ischemic stroke, higher pre- and post-MT SBP levels are associated with increased mortality and lower odds of functional independence at three months (). This highlights the importance of careful BP management in patients undergoing MT to improve clinical outcomes.
Conclusion
The relationship between blood pressure and stroke is well-established, with high BP being a significant risk factor for both the occurrence and recurrence of stroke. Effective BP management, including the use of antihypertensive agents, can substantially reduce the risk of stroke and improve outcomes in stroke patients. However, the optimal approach to BP management during the acute phase of stroke requires further investigation. Overall, maintaining lower BP levels is crucial for stroke prevention and improving long-term outcomes in stroke patients.
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