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Safety of induced hypertension therapy in patients with acute ischemic stroke

Neurocritical Care volume 4, pages 3–7 (2006)Cite this article

Abstract

Introduction

The management of blood pressure in acute stroke is controversial. Small pilot studies have suggested that blood pressure augmentation improves short-term neurological function, but the rate of adverse events with induced hypertension (IH) therapy is unknown.

Methods and Results

We reviewed 100 consecutive patients who underwent perfusion magnetic resonance imaging for acute ischemic stroke. IH therapy was employed in 46 patients and standard therapy (ST) in 54. The two groups had similar baseline characteristics, but more patients in the IH group had significant large-artery stenoses. The IH group achieved significantly higher mean arterial pressure (MAP) than the ST group within 3 days of initiation of therapy with a variety of vasopressor agents. Only 35% of patients in the IH group actually achieved the target MAP augmentation of 10–20% above baseline, however. All patients survived to discharge. Four patients experienced major adverse events in each group. Two patients in the IH group experienced intracerebral hemorrhage compared to none in the ST group. Two patients in the ST group experienced myocardial ischemia, compared to none in the IH group. The National Institutes of Health Stroke Scale during the hospitalization and place of discharge were similar in both groups. Patients in the IH group were more likely to be admitted to the intensive care unit and had a longer hospital stay by nearly 4 days compared to the ST group.

Conclusion

These data demonstrate the relative safety of IH therapy in acute stroke patients. Given the greater use of resources, however, the role of IH in improving clinical outcomes requires a prospective, randomized trial.

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References

  1. Jansen PAF, Schulte BPM, Poels EFJ, Gribnau FWJ. Course of blood pressure after cerebral infarction and transient ischemic attack. Clin Neurol Neurosurg 1987;89:243–246.

    PubMed  Article  CAS  Google Scholar 

  2. Adams HP, Brott TG, Crowell RM, et al. Guidelines for the management of patients with acute ischemic stroke. A statement for healthcare professionals from a special writing group of the Stroke Counci, American Heart Association. Stroke 1994;25:1901–1914.

    PubMed  Google Scholar 

  3. PROGRESS Collaborative Group. Randomised trial of perindopril-based blood pressure lowering regimen among 6,105 patients with prior stroke or transient ischaemic attack. Lancet 2001;358:995–1003.

    Google Scholar 

  4. Vemmos KN, Tsivgoulis G, Spengos K, et al. Pulse pressure in acute stroke is an independent predictor of long-term mortality. Cerebrovasc Dis 2004;18:30–36.

    PubMed  Article  Google Scholar 

  5. Hayashi S, Nehls DG, Kieck CF, Velma J, DeGirolami U, Crowell RM. Beneficial effects of induced hypertension on experirmental stroke in awake monkeys. J Neurosurg 1985;60:151–157.

    Google Scholar 

  6. Drummond JC, Oh YS, Cole DJ, Shapiro HM. Phenylephrine-induced hypertension reduces ischemia following middle cerebral artery occlusion in rats. Stroke 1989;20:1534–1538.

    Google Scholar 

  7. Hosomi N, Tsuda Y, Ichihara SI, Kitadai M, Ohyama H, Matsuo H. Duration threshold of induced hypertension on cerebral blood flow, energy metabolism, and edema after transient forebrain ischemia in gerbils. J Cereb Blood Flow Metab 1996;16:1224–1229.

    PubMed  Article  CAS  Google Scholar 

  8. Wise G, Sutter R, Burkholder J. The treatment of brain ischemia with vasopressor drugs. Stroke 1972;3:135–140.

    PubMed  CAS  Google Scholar 

  9. Rordorf G, Cramer SC, Efird JT, Schwamm LH, Buonanno F, Koroshetz W. Pharmacological elevation of blood pressure in acute stroke. Stroke 1997;28:2133–2138.

    PubMed  CAS  Google Scholar 

  10. Rordorf G, Koroshetz W, Ezzeddine MA, Segal AZ, Buonanno FS. A pilot study of drug-induced hypertension for treatment of acute stroke. Neurology 2001;56:1210–1213.

    PubMed  CAS  Google Scholar 

  11. Hillis AE, Ulatowski JA, Barker PB, et al. A pilot randomized trial of induced blood pressure elevation: Effects on function and focal perfusion in acute and subacute stroke. Cerebrovasc Dis 2003;16:236–246.

    PubMed  Article  CAS  Google Scholar 

  12. Hillis AE, Kane A, Tuffiash E, et al. Reperfusion of specific brain regions by raising blood pressure restores selective language functions in subacute stroke. Brain and Language 2001;79:495–510.

    PubMed  Article  CAS  Google Scholar 

  13. Skyhøj Olsen T, Larsen B, Herning M, Skriver EB, Lassen N. Blood flow and vascular reactivity in collaterally perfused brain tissue. Stroke 1983;14:332–401.

    Google Scholar 

  14. Baron JC, Marchal G. Functional imaging in vascular disorders. In: Mazziotta JC, Toga AW, Frackowiak RSJ, eds. Brain Mapping: The Disorders. San Diego: Academic Press, 2000:299–311.

    Chapter  Google Scholar 

  15. Hatashita S, Hoff J, Ishii S. Focal brain edema associated with acute arterial hypertension. J Neurosurg 1986;64:643–649.

    PubMed  CAS  Article  Google Scholar 

  16. Chamorro A, Vila N, Ascaso C, Elices E, Schonwille W, Blanc R. Blood pressure and functional recovery in acute ischemic stroke. Stroke 1998;29:1850–1853.

    PubMed  CAS  Google Scholar 

  17. Mayberg MR, Batjer HH, Dacey R, et al. Guidelines for the man agement of aneurysmal subarachnoid hemorrhage. A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 1994;25:2315–2328.

    PubMed  CAS  Google Scholar 

  18. Miller JA, Dacey RG, Diringer MN. Safety of hypertensive hypervolemic therapy with phenylephrine in the treatment of delayed ischemic deficits after subarachnoid hemorrhage. Stroke 1995;26:2260–2266.

    PubMed  CAS  Google Scholar 

  19. Restrepo L, Jacobs MA, Barker PB, et al. Etiology of Perfusion-Diffusion Mismatch. J Neuroimaging 2005;11:1–7.

    Google Scholar 

  20. Kasner SE, Cucchiara BL, McGarvey ML, Luciano JM, Liebeskind DS, Chalela JA. Modified National Institutes of Health Stroke Scale can be estimated from medical records. Stroke 2003;34:568–570.

    PubMed  Article  Google Scholar 

  21. Kasner SE, Chalela JA, Luciano JM, et al. Reliability and validity of estimating the NIH stroke scale score from medical records. Stroke 1999;30:1534–1537.

    PubMed  CAS  Google Scholar 

  22. Adams HP Jr, Woolson RF, Clarke WR, et al. Design of the Trial of Org 10172 in Acute Stroke Treatment (TOAST) Control Clin Trials 1997;18:358–377.

    PubMed  Article  Google Scholar 

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Affiliations

  1. Department of Physiological Science, University of California, Los Angeles, CA

    Lucas Restrepo

  2. Department of Neurology, Johns Hopkins Hospital, Baltimore, MD

    Robert J. Wityk

  3. Neurosciences Critical Care, Johns Hopkins Hospital, 600 N. Wolfe St. Meyer 8-140, 21287, Baltimore, MD

    Matthew A. Koenig, Romergryko G. Geocadin, Megan de Grouchy, James Glasgow & Sangeetha Vimal

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  1. Matthew A. Koenig
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  2. Romergryko G. Geocadin
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  3. Megan de Grouchy
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  4. James Glasgow
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  5. Sangeetha Vimal
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  6. Lucas Restrepo
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  7. Robert J. Wityk
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Correspondence to Matthew A. Koenig.

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Koenig, M.A., Geocadin, R.G., de Grouchy, M. et al. Safety of induced hypertension therapy in patients with acute ischemic stroke. Neurocrit Care 4, 3–7 (2006). https://doi.org/10.1385/NCC:4:1:003

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Key Words

  • Induced hypertension
  • vasopressors
  • acute stroke