What is stroke blood pressure
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Understanding Stroke Blood Pressure: Key Insights from Research
High Blood Pressure in Acute Stroke: Impact on Outcomes
High blood pressure (BP) is a common occurrence in acute stroke patients and is often linked to poor outcomes. A systematic review of 32 studies involving 10,892 patients found that elevated mean arterial BP (MABP) and high diastolic BP (DBP) were significantly associated with increased mortality. Specifically, high systolic BP (SBP) and DBP were linked to combined death or dependency in primary intracerebral hemorrhage (PICH) and ischemic stroke. This suggests that managing BP levels in acute stroke patients is crucial for improving survival and reducing dependency.
Blood Pressure Control for Stroke Prevention
Stroke is a leading cause of death and disability globally, with high BP being the most significant modifiable risk factor. Clinical trials have shown that antihypertensive therapy can substantially reduce the risk of stroke, stroke-related death, and disability. The risk of stroke increases with BP levels above 115/75 mm Hg, and features like nocturnal hypertension and morning surge further elevate this risk. Therefore, effective BP management is essential for both primary and secondary stroke prevention.
Challenges in Managing Blood Pressure During Acute Stroke
Managing BP in acute stroke presents a dilemma. Elevated SBP levels (≥160 mmHg) are common in acute stroke, affecting up to 60% of patients, while low SBP levels (≤140 mmHg) also pose risks. The optimal management strategy remains unclear due to limited data from randomized, placebo-controlled trials. Both high and low BP levels can lead to increased morbidity and mortality, highlighting the need for more research to determine the best therapeutic approach.
Guidelines for Blood Pressure Management in Acute Stroke
The European Stroke Organisation (ESO) provides evidence-based guidelines for BP management in acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH). These guidelines recommend early and modest BP control, avoiding levels above 180/105 mm Hg in AIS patients undergoing reperfusion therapies. For acute ICH, intensive BP lowering is advised to improve recovery by reducing hematoma expansion. Despite these recommendations, there is ongoing uncertainty, and further randomized-controlled trials are needed to refine BP management strategies.
Intensive vs. Standard Blood Pressure Control
A randomized clinical trial and meta-analysis assessed the effects of intensive BP control (target <120/80 mm Hg) versus standard control (target <140/90 mm Hg) on recurrent stroke. The study found that intensive BP lowering tended to reduce stroke recurrence, supporting a target BP of less than 130/80 mm Hg for secondary stroke prevention. This suggests that more aggressive BP management may be beneficial for patients with a history of stroke.
Blood Pressure Variability and Stroke Prognosis
Short-term BP variability (BPV) after stroke is an important prognostic factor. A systematic review and meta-analysis indicated that greater systolic BPV is associated with poor functional outcomes, including increased risk of death or disability. This highlights the need for future studies to determine the best methods for measuring and managing BPV in acute stroke patients.
Conclusion
High blood pressure is a critical factor in both the occurrence and outcome of strokes. Effective BP management, including the use of antihypertensive therapy and careful monitoring of BP variability, is essential for improving patient outcomes. While current guidelines provide a framework for BP management in acute stroke, ongoing research is necessary to refine these strategies and ensure optimal care for stroke patients.
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