TY - JOUR AU - Anderson Craig AU - Carcel C. AB -

Whether there are any benefits without harm from early lowering of blood pressure (BP) in the setting of acute ischemic stroke (AIS) has been a longstanding controversy in medicine. Whilst most studies have consistently shown associations between elevated BP, particularly systolic BP, and poor outcome, some also report that very low BP (systolic <130 mmHg) and large reductions in systolic BP are associated with poor outcomes in AIS. However, despite these associations, the observed U- or J-shaped relationship between BP and outcome in these patients may not be causally related. Patients with more severe strokes may have a more prominent autonomic response and later lower BP as their condition worsens, often pre-terminally. Fortunately, substantial progress has been made in recent years with new evidence arising from well-conducted randomized trials. This review outlines new evidence and recommendations for clinical practice over BP management in AIS.

AD - The George Institute for Global Health, Sydney, Australia. AN - 26041479 BT - Current Atherosclerosis Reports DP - NLM ET - 2015/06/05 LA - eng LB - NMH
AUS M1 - 8 N1 - Carcel, Cheryl
Anderson, Craig S
United States
Curr Atheroscler Rep. 2015 Aug;17(8):520. doi: 10.1007/s11883-015-0520-y. N2 -

Whether there are any benefits without harm from early lowering of blood pressure (BP) in the setting of acute ischemic stroke (AIS) has been a longstanding controversy in medicine. Whilst most studies have consistently shown associations between elevated BP, particularly systolic BP, and poor outcome, some also report that very low BP (systolic <130 mmHg) and large reductions in systolic BP are associated with poor outcomes in AIS. However, despite these associations, the observed U- or J-shaped relationship between BP and outcome in these patients may not be causally related. Patients with more severe strokes may have a more prominent autonomic response and later lower BP as their condition worsens, often pre-terminally. Fortunately, substantial progress has been made in recent years with new evidence arising from well-conducted randomized trials. This review outlines new evidence and recommendations for clinical practice over BP management in AIS.

PY - 2015 SN - 1534-6242 (Electronic)
1523-3804 (Linking) EP - 520 T2 - Current Atherosclerosis Reports TI - Timing of blood pressure lowering in acute ischemic stroke VL - 17 Y2 - FY16 ER -