Blood Pressure Management in Acute Ischemic Stroke
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GUIDELINES / CLINICAL TRIALS/META-ANALYSIS (WJ KOSTIS, SECTION EDITOR)
Blood Pressure Management in Acute Ischemic Stroke Dariusz Gąsecki 1 & Mariusz Kwarciany 1 & Kamil Kowalczyk 1 & Krzysztof Narkiewicz 2 & Bartosz Karaszewski 1
# The Author(s) 2020
Abstract Purpose of Review Abrupt blood pressure (BP) rise is the most common clinical symptom of acute ischemic stroke (AIS). However, BP alterations during AIS reflect many diverse mechanisms, both stroke-related and nonspecific epiphenomena, which change over time and across patients. While extremes of BP as well as high BP variability have been related with worse outcomes in observational studies, optimal BP management after AIS remains challenging. Recent Findings This review discusses the complexity of the factors linking BP changes to the clinical outcomes of patients with AIS, depending on the treatment strategy and local vessel status and, in particular, the degree of reperfusion achieved. The evidence for possible additional clinical markers, including the presence of arterial hypertension, and comorbid organ dysfunction in individuals with AIS, as informative and helpful factors in therapeutic decision-making concerning BP will be reviewed, as well as recent data on neurovascular monitoring targeting person-specific local cerebral perfusion and metabolic demand, instead of the global traditional parameters (BP among others) alone. Summary The individualization of BP management protocols based on a complex evaluation of the homeostatic response to focal cerebral ischemia, including but not limited to BP changes, may be a valuable novel goal proposed in AIS, but further trials are warranted. Keywords Blood pressure . Hypertension . Acute ischemic stroke . Management
Introduction Stroke is globally a leading cause of mortality and long-term disability in adults. Even though the prevalence and death rate due to stroke have decreased over the last years, the overall burden remains high, and the absolute number of people affected continues to increase [1, 2]. Acute ischemic stroke (AIS) accounts for approximately 70–85% of all strokes worldwide. AIS is caused by a critical reduction in blood flow to the brain. Cerebral blood flow (CBF) is almost totally arrested in the core region of the insult, which leads to neuronal death This article is part of the Topical Collection on Guidelines / Clinical Trials/Meta-Analysis * Dariusz Gąsecki [email protected] 1
Department of Adult Neurology, Medical University of Gdańsk, ul, Dębinki 7, 80-952 Gdańsk, Poland
2
Department of Hypertension and Diabetology, Medical University of Gdańsk, ul, Dębinki 7, 80-952 Gdańsk, Poland
within minutes. The tissue surrounding the core is severely hypoperfused and functionally impaired but still viable. This zone, called the penumbra, is at high risk of infarction. It permits cell survival for a certain period of time; however, it is extremely vulnerable to CBF fluctuations, which depend on both local and global factors, such as cerebral vasoreactivity or collaterals and systemic
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