scholarly journals Blood Pressure Management in Stroke

Hypertension ◽  
2020 ◽  
Vol 76 (6) ◽  
pp. 1688-1695
Author(s):  
Philip B. Gorelick ◽  
Paul K. Whelton ◽  
Farzaneh Sorond ◽  
Robert M. Carey
Keyword(s):  
Blood Pressure ◽  
Recurrent Stroke ◽  
Pressure Control ◽  
Disability Adjusted Life Years ◽  
Pressure Management ◽  
Stroke Treatment ◽  
Blood Pressure Management ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Acute Stroke Treatment

Hypertension is a well-established and modifiable risk factor for stroke and other cardiovascular diseases. Notably, stroke is the second leading cause of death worldwide and the second most common cause of disability-adjusted life-years. As such, we provide a viewpoint on blood pressure management in stroke and emphasize blood pressure control or management for first and recurrent stroke prevention, acute stroke treatment, and for prevention of cognitive impairment or dementia.

scholarly journals Time course of blood pressure control prior to lacunar TIA and stroke

Neurology ◽  
2018 ◽  
Vol 90 (20) ◽  
pp. e1732-e1741 ◽  
Author(s):  
Linxin Li ◽  
Sarah J.V. Welch ◽  
Sergei A. Gutnikov ◽  
Ziyah Mehta ◽  
Peter M. Rothwell ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Time Course ◽  
Temporal Trends ◽  
Pressure Control ◽  
Population Based ◽  
Direct Role ◽  
Population Based Study ◽  
Stroke Treatment ◽  
Acute Stroke Treatment

ObjectiveTo determine the age-specific temporal trends in blood pressure (BP) before acute lacunar vs nonlacunar TIA and stroke.MethodsIn a population-based study of TIA/ischemic stroke (Oxford Vascular Study), we studied 15-year premorbid BP readings from primary care records in patients with lacunar vs nonlacunar events (Trial of Org 10172 in Acute Stroke Treatment [TOAST]) stratified by age (<65, ≥65 years).ResultsOf 2,085 patients (1,250 with stroke, 835 with TIA), 309 had lacunar events. In 493 patients <65 years of age, the prevalence of diagnosed hypertension did not differ between lacunar and nonlacunar events (46 [48.4%] vs 164 [41.2%], p = 0.20), but mean/SD premorbid BP (44,496 BP readings) was higher in patients with lacunar events (15-year records: systolic BP [SBP] 138.5/17.7 vs 133.3/15.0 mm Hg, p = 0.004; diastolic BP [DBP] 84.1/9.6 vs 80.9/8.4 mm Hg, p = 0.001), mainly because of higher mean BP during the 5 years before the event (SBP 142.6/18.8 vs 134.6/16.6 mm Hg, p = 0.0001; DBP 85.2/9.7 vs 80.6/9.0 mm Hg, p < 0.0001), with a rising trend (ptrend = 0.006) toward higher BP leading up to the event (<30-day pre-event SBP: 152.7/16.1 vs 135.3/23.1 mm Hg, p = 0.009; DBP 87.9/9.4 vs 80.8/12.8 mm Hg, p = 0.05; mean BP ≤1 year before the event 145.8/22.0 vs 134.7/16.1 mm Hg, p = 0.001; 86.1/10.7 vs 80.4/9.8 mm Hg, p = 0.0001). Maximum BP in the 5 years before the event was also higher in patients with lacunar events (SBP 173.7/26.6 vs 158.6/23.2 mm Hg, p = 0.0001; DBP 102.3/12.9 vs 94.2/11.2 mm Hg, p < 0.0001), as was persistently elevated BP (≥50% SBP >160 mm Hg, odd ratio 4.95, 95% confidence interval 1.99–12.31, p = 0.0002). However, no similar differences in BP were observed in patients ≥65 years of age.ConclusionRecent premorbid BP control is strongly temporarily related to acute lacunar events at younger ages, suggesting a direct role of BP in accelerating causal pathology and highlighting the need to control hypertension quickly.

Abstract P402: Blood Pressure Control Poses Significant Delays to Discharge After an Acute Ischemic Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Hannah Y Chan ◽  
Brian Gulbis ◽  
Sean I Savitz ◽  
Teresa A Allison
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Length Of Stay ◽  
Acute Ischemic Stroke ◽  
Pressure Control ◽  
Pressure Management ◽  
Chi Square ◽  
Improvement Project ◽  
Blood Pressure Management ◽  
The Impact

Acute ischemic stroke (AIS) patients often experience an extended length of stay (LOS) due to multiple factors, including blood pressure management (BPM). The aim of this quality improvement project was to assess the impact of BPM on LOS in AIS patients. This was a retrospective review of 99 AIS patients randomly selected at a comprehensive stroke center from January to June 2020. The primary outcome was the percentage of patients with LOS observed/expected (O/E) ratio ≥ 0.8. Factors associated with delayed hospital discharge (DHD) were evaluated. Chi-square, student t-test, and Mann-Whitney U test were used as appropriate for analysis. Patients had a mean (SD) age of 65 (14) years, median (IQR) NIHSS 7 (4, 15), HTN history (67%), and were African American (40%), Caucasian (32%), or Other (28%). Table 1 shows types of strokes. Twenty-three (23%) patients received tPA. Forty-five (45%) patients had a LOS O/E ratio of ≥ 0.8. Reasons for DHD included BPM (38%), medical management (33%), stroke management (25%), and disposition (4%). Patients with DHD had an initial mean (SD) SBP of 164 (32) mmHg compared to 161 (33) mmHg in patients with no DHD, p=0.603. Figure 1 shows mean SBP trends. Patients with DHD had a median (IQR) of 2 (0, 3) home BP medications compared to 1 (0, 2) in patients with no DHD, p=0.040. Nine patients (20%) with DHD compared to 7 patients (13%) with no DHD were initiated on a nicardipine drip upon admission, p = 0.416. Oral therapy was initiated on median (IQR) hospital day 2.5 (2, 3) in DHD patients vs. 3 (2, 3) in patients with no DHD, p = 0.951. Median (IQR) number of BP medications on discharge was 2 (1, 2) in DHD patients vs. 1 (0, 2) in patients with no DHD, p=0.170. Reasons for elevated BP included delayed therapy initiation (12%), medication titration (59%), and titration intolerability (29%). Blood pressure management in this cohort was one of the most significant factors in delaying discharge. Protocols should focus on better and faster BPM as a means of reducing length of stay.

Identifying Public Health Problems

2018 ◽  
Author(s):  
Scott Burris ◽  
Micah L. Berman ◽  
Matthew Penn, and ◽  
Tara Ramanathan Holiday
Keyword(s):  
Public Health ◽  
Health Problems ◽  
Health Priorities ◽  
Disability Adjusted Life Years ◽  
Quality Adjusted Life Years ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Study Designs ◽  
Quality Adjusted Life

Chapter 5 discusses the use of epidemiology to identify the source of public health problems and inform policymaking. It uses a case study to illustrate how researchers, policymakers, and practitioners detect diseases, identify their sources, determine the extent of an outbreak, and prevent new infections. The chapter also defines key measures in epidemiology that can indicate public health priorities, including morbidity and mortality, years of potential life lost, and measures of lifetime impacts, including disability-adjusted life years and quality-adjusted life years. Finally, the chapter reviews epidemiological study designs, differentiating between experimental and observational studies, to show how to interpret data and identify limitations.

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