Stroke blood pressure
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Blood Pressure Management in Stroke: Key Insights from Recent Research
Blood Pressure and Stroke Risk Reduction
Impact of Blood Pressure Lowering on Stroke Risk
Lowering blood pressure (BP) has been consistently shown to reduce the risk of stroke. A meta-analysis of over 40 randomized controlled trials involving more than 188,000 participants revealed that a 10 mm Hg reduction in systolic BP is associated with a one-third reduction in stroke risk across various populations and age groups . This association holds true for both fatal and nonfatal stroke events and is consistent across different regions and sexes . Furthermore, the benefits of BP reduction are more pronounced with larger reductions in BP .
Long-Term Blood Pressure Control
Prolonged differences in diastolic BP (DBP) also significantly impact stroke risk. Studies indicate that a sustained reduction in DBP by 5, 7.5, and 10 mm Hg can lead to at least 34%, 46%, and 56% reductions in stroke risk, respectively. This highlights the importance of maintaining long-term BP control to mitigate stroke risk effectively.
Blood Pressure Management in Acute Stroke
High Blood Pressure in Acute Stroke
High BP is common in acute stroke and is associated with poor outcomes, including increased mortality and dependency. A systematic review of 32 studies involving 10,892 patients found that elevated mean arterial BP (MABP) and diastolic BP (DBP) were significantly associated with higher odds of death and dependency in both ischemic stroke and primary intracerebral hemorrhage (PICH). This suggests that moderate BP lowering in the acute phase of stroke might improve outcomes.
Guidelines for Acute Stroke Management
The European Stroke Organisation (ESO) guidelines recommend early and modest BP control in acute ischemic stroke (AIS) patients undergoing reperfusion therapies, aiming to keep BP levels below 180/105 mm Hg. For acute intracerebral hemorrhage (ICH), intensive BP lowering is recommended to reduce hematoma expansion and improve recovery. However, there remains uncertainty regarding the optimal BP management strategy in different acute stroke subgroups, necessitating further randomized-controlled trials.
Blood Pressure Variability and Stroke Outcomes
Prognostic Significance of Blood Pressure Variability
Short-term BP variability (BPV) after stroke is an important prognostic factor. Greater systolic BPV is associated with poor functional outcomes, including increased risk of death or disability. This association underscores the need for future studies to determine the best methods for measuring and managing BPV in acute stroke patients.
Intensive vs. Standard Blood Pressure Control
Secondary Stroke Prevention
Intensive BP control, targeting levels below 120/80 mm Hg, has been shown to reduce the risk of recurrent stroke compared to standard BP control (below 140/90 mm Hg). A randomized clinical trial and subsequent meta-analysis indicated that intensive BP lowering tends to reduce stroke recurrence, supporting a target BP of less than 130/80 mm Hg for secondary stroke prevention.
Conclusion
Effective BP management is crucial in both the prevention and acute management of stroke. Lowering BP significantly reduces stroke risk, and maintaining long-term BP control is essential. In acute stroke, moderate BP lowering can improve outcomes, and intensive BP control may be beneficial for secondary stroke prevention. However, further research is needed to refine BP management strategies, particularly in the acute phase of stroke.
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