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Chen Y, Ma Y, Qin J, Wei X, Yang Y, Yuan Y, Yan F, Huo X, Han L. Blood pressure variability predicts poor outcomes in acute stroke patients without thrombolysis: a systematic review and meta-analysis. J Neurol 2024; 271:1160-1169. [PMID: 38036920 DOI: 10.1007/s00415-023-12054-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Stroke is a significant medical condition, and blood pressure stands out as the most prevalent treatable risk factor associated with it. Researches link blood pressure variability (BPV) with stroke; however, the specific relationship between with the outcomes of stroke patients remains unclear. As blood pressure variability and mean blood pressure are interrelated, it remains uncertain whether BPV adds additional information to understanding the outcome of acute stroke patients. OBJECTIVE To systematically review studies investigating the association between blood pressure variability and prognosis in acute stroke patients. METHODS Embase, PubMed, Web of Science, and the Cochrane Library were searched for English language full-text articles from the inception to 1 January 2023. Stroke patients aged ≥ 18 years were included in this analysis. Stroke types were not restricted. RESULTS This meta-analysis shows that higher systolic blood pressure variability is linked to a higher risk of poor outcome, including function disability, mortality, early neurological deterioration, and stroke recurrence, among acute stroke patients without thrombolysis. A higher diastolic blood pressure variability is linked with to a higher risk of mortality and functional disability. CONCLUSIONS This review reveals that blood pressure variability is a novel and clinically relevant risk factor for stroke patients' outcome. Future studies should investigate how best to measure and define BPV in acute stroke. Larger studies are warranted to provide more robust evidence in this area.
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Affiliation(s)
- Yajing Chen
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
| | - Yuxia Ma
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China.
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730030, Gansu Province, China.
| | - Jiangxia Qin
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
| | - Xiaoqin Wei
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
| | - Yiyi Yang
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
| | - Yue Yuan
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
| | - Fanghong Yan
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
| | - Xiaoning Huo
- The Third People's Hospital of Lanzhou, No.130 Jianlan New Village, Lanzhou, Gansu Province, China
| | - Lin Han
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China.
- Department of Nursing, Gansu Provincial Hospital, No. 204 Donggang West Road, Lanzhou, Gansu Province, China.
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Katsanos AH, Joundi RA, Palaiodimou L, Ahmed N, Kim JT, Goyal N, Maier IL, de Havenon A, Anadani M, Matusevicius M, Mistry EA, Khatri P, Arthur AS, Sarraj A, Yaghi S, Shoamanesh A, Catanese L, Psychogios MN, Tsioufis K, Malhotra K, Spiotta AM, Sandset EC, Alexandrov AV, Petersen NH, Tsivgoulis G. Blood Pressure Trajectories and Outcomes After Endovascular Thrombectomy for Acute Ischemic Stroke. Hypertension 2024; 81:629-635. [PMID: 38164751 DOI: 10.1161/hypertensionaha.123.22164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/12/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Data on systolic blood pressure (SBP) trajectories in the first 24 hours after endovascular thrombectomy (EVT) in acute ischemic stroke are limited. We sought to identify these trajectories and their relationship to outcomes. METHODS We combined individual-level data from 5 studies of patients with acute ischemic stroke who underwent EVT and had individual blood pressure values after the end of the procedure. We used group-based trajectory analysis to identify the number and shape of SBP trajectories post-EVT. We used mixed effects regression models to identify associations between trajectory groups and outcomes adjusting for potential confounders and reported the respective adjusted odds ratios (aORs) and common odds ratios. RESULTS There were 2640 total patients with acute ischemic stroke included in the analysis. The most parsimonious model identified 4 distinct SBP trajectories, that is, general directional patterns after repeated SBP measurements: high, moderate-high, moderate, and low. Patients in the higher blood pressure trajectory groups were older, had a higher prevalence of vascular risk factors, presented with more severe stroke syndromes, and were less likely to achieve successful recanalization after the EVT. In the adjusted analyses, only patients in the high-SBP trajectory were found to have significantly higher odds of early neurological deterioration (aOR, 1.84 [95% CI, 1.20-2.82]), intracranial hemorrhage (aOR, 1.84 [95% CI, 1.31-2.59]), mortality (aOR, 1.75 [95% CI, 1.21-2.53), death or disability (aOR, 1.63 [95% CI, 1.15-2.31]), and worse functional outcomes (adjusted common odds ratio,1.92 [95% CI, 1.47-2.50]). CONCLUSIONS Patients follow distinct SBP trajectories in the first 24 hours after an EVT. Persistently elevated SBP after the procedure is associated with unfavorable short-term and long-term outcomes.
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Affiliation(s)
- Aristeidis H Katsanos
- Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, Canada (A.H.K., R.A.J., A.S., L.C.)
| | - Raed A Joundi
- Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, Canada (A.H.K., R.A.J., A.S., L.C.)
| | - Lina Palaiodimou
- Second Department of Neurology, Attikon University Hospital, School of Medicine (L.P., G.T.), National and Kapodistrian University of Athens, Greece
| | - Niaz Ahmed
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (N.A., M.M.)
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (N.A., M.M.)
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea (J.-T.K.)
| | - Nitin Goyal
- Department of Neurology (N.G., G.T., A.V.A.), University of Tennessee Health Science Center, Memphis
- Department of Neurosurgery (N.G., A.S.A.), University of Tennessee Health Science Center, Memphis
| | - Ilko L Maier
- Department of Neurology, University Medical Center Goettingen, Germany (I.L.M.)
| | - Adam de Havenon
- Department of Neurology, Clinical Neurosciences Center, University of Utah, Salt Lake City (A.d.H.)
| | - Mohammad Anadani
- Department of Neurology, (M.A.), Medical University of South Carolina, Charleston
- Department of Neurosurgery (MA., A.M.S.), Medical University of South Carolina, Charleston
| | - Marius Matusevicius
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (N.A., M.M.)
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (N.A., M.M.)
| | - Eva A Mistry
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee (E.A.M.)
| | - Pooja Khatri
- Department of Neurology, University of Cincinnati, Ohio (P.K.)
| | - Adam S Arthur
- Department of Neurosurgery (N.G., A.S.A.), University of Tennessee Health Science Center, Memphis
| | - Amrou Sarraj
- Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, Canada (A.H.K., R.A.J., A.S., L.C.)
| | - Shadi Yaghi
- Department of Neurology, NYU Langone Health, New York, NY (S.Y.)
| | - Ashkan Shoamanesh
- Department of Neurology, Case Western Reserve University, University Hospitals Cleveland Medical Center, OH (A.S.)
| | - Luciana Catanese
- Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, Canada (A.H.K., R.A.J., A.S., L.C.)
| | - Marios-Nikos Psychogios
- Department of Neuroradiology, Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland (M.-N.P.)
| | - Konstantinos Tsioufis
- First Department of Cardiology, Hippokration Hospital (K.T.), National and Kapodistrian University of Athens, Greece
| | - Konark Malhotra
- Department of Neurology, Allegheny Health Network, Pittsburgh, Pennsylvania (K.M.)
| | - Alejandro M Spiotta
- Department of Neurosurgery (MA., A.M.S.), Medical University of South Carolina, Charleston
| | | | - Andrei V Alexandrov
- Department of Neurology (N.G., G.T., A.V.A.), University of Tennessee Health Science Center, Memphis
| | - Nils H Petersen
- Department of Neurology, Yale University, New Haven (N.H.P.)
| | - Georgios Tsivgoulis
- Second Department of Neurology, Attikon University Hospital, School of Medicine (L.P., G.T.), National and Kapodistrian University of Athens, Greece
- Department of Neurology (N.G., G.T., A.V.A.), University of Tennessee Health Science Center, Memphis
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Shi M, Liu Y, Wang S, Wang R, Yang P, Peng Y, Peng H, Wang A, Xu T, Chen J, Zhang Y, He J. Blood pressure control and antihypertensive medication use after discharge and prognosis of ischemic stroke. J Hypertens 2023; 41:1730-1737. [PMID: 37796208 DOI: 10.1097/hjh.0000000000003523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
OBJECTIVE To investigate the effect of consistently blood pressure (BP) control status after discharge on adverse clinical outcomes among ischemic stroke (IS) patients. METHODS Three thousand, four hundred and six acute IS patients were included and followed up at 3 months, 12 months, and 24 months after stroke. Study outcomes were defined as death, vascular events and composite of death or vascular events. Cox proportional hazard models were used to estimate hazard ratios (HR) and 95% confident interval (CI) of death and the composite outcome of death or vascular events associated with BP control and antihypertensive medication use. RESULTS The multivariable adjusted HRs were 0.22 [95% confidence interval (CI): 0.09-0.57] for death and 0.60 (95% CI: 0.39-0.97) for the composite outcome of death or vascular events among participants with consistently controlled BP compared with those with consistently uncontrolled BP. The participants with both consistently controlled BP and regular use of antihypertensive medication had the lowest risks of death [hazard ratio (HR): 0.18, 95% CI: 0.04-0.75] and composite outcome of death or vascular events (HR: 0.54, 95% CI: 0.29-0.98) in comparison with those with both uncontrolled BP and irregular use of antihypertensive medication. DISCUSSION Continuous BP control and regular use of antihypertensive medications after discharge can decrease the risks of death and composite outcome of death or vascular events among IS patients, suggesting the importance of continuous BP control and regular use of antihypertensive medications after discharge for improving prognosis of IS.
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Affiliation(s)
- Mengyao Shi
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Yang Liu
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou
| | - Shuyao Wang
- Department of Neurology, Tongliao Municipal Hospital, Tongliao
| | - Ruirui Wang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China
| | - Pinni Yang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China
| | - Yanbo Peng
- Department of Neurology, Affiliated Hospital of North China University of Science and Technology, Tangshan, China
| | - Hao Peng
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China
| | - Aili Wang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China
| | - Tan Xu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China
| | - Jing Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Yonghong Zhang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, China
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
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Yun HR, Su Joo Y, Ik Chang T, Wha Kang E, Son NH, Woo Kim H, Tak Park J, Yoo TH, Kang SW, Hyeok Han S. Association of short-term and long-term weight loss with the risk of major adverse cardiovascular disease: Community-based cohort study. Diabetes Res Clin Pract 2023; 195:110193. [PMID: 36464088 DOI: 10.1016/j.diabres.2022.110193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 11/23/2022] [Accepted: 11/25/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND This study evaluated temporal association of changes in BMI over time with major adverse cardiovascular event (MACE) in Korean middle-aged adults. METHODS Between 2001 and 2002, 6855 individuals from the Korean Genome and Epidemiology Study were included and followed up until 2014. The main predictor was the change in BMI determined using group-based trajectory modelling (decreasing, stable, and increasing) from the baseline to 4-, 6-, and 8-years of follow-up. The primary outcome was the occurrence of MACE. RESULTS During the mean 10.2 years follow-up, MACEs occurred in 350 (5.1 %) individuals. The median (interquartile rage) age of study population was 50 (44-59) years. In primary analysis with 4-year trajectory model, decreasing BMI trajectory was associated with a 1.41-fold higher risk of the MACEs (hazard ratio [HR], 1.41; 95 % confidence interval [CI], 1.06-1.91) compared with stable BMI trajectory. In secondary analyses with 6- and 8-year trajectory models, this association disappeared, and the corresponding HRs (95 % CIs) were 1.14 (0.81-1.61) and 0.98 (0.65-1.49), respectively. There were concomitant improvements in cardiometabolic risk factors in decreasing BMI group, but unfavorable risk burden remained up to 4 to 6 years. CONCLUSIONS The initial 4-year weight loss was paradoxically associated with a higher risk of MACEs, probably due to residual cardiovascular burden. However, this association became null in participants with sustained weight loss ≥ 6 years, suggesting a possible lag effect of weight loss on MACEs.
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Affiliation(s)
- Hae-Ryong Yun
- Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Su Joo
- Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae Ik Chang
- Department of Internal Medicine, National Health Insurance Service Medical Center, Ilsan Hospital, Goyang, Gyeonggi-do, Republic of Korea
| | - Ea Wha Kang
- Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Nak-Hoon Son
- Department of Statistics, Keimyung University, Daegu, Republic of Korea
| | - Hyung Woo Kim
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - Jung Tak Park
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea; Department of Internal Medicine, College of Medicine, Severance Biomedical Science Institute, Brain Korea 21 PLUS, Yonsei University, Seoul, Republic of Korea
| | - Seung Hyeok Han
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea.
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Association between the Systolic Blood Pressure Trajectory and Risk of Stroke in a Health-Management Population in Jiaozuo, China. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:7472188. [PMID: 36619241 PMCID: PMC9812623 DOI: 10.1155/2022/7472188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 12/31/2022]
Abstract
The trajectories of systolic blood pressure (SBP) in a screening population in Jiaozuo were examined, and the association between the different types of SBP trajectories and the risk of stroke was evaluated. Data of a fixed cohort population from the Jiaozuo Stroke Prevention and Control Project Management Special Database System that underwent community screening in 2015, 2017, 2019, and 2021 were collected. Ultimately, a total of 1,451 participants who met the inclusion criteria for this study were included in the analysis, which was performed using group trajectory modeling. The baseline SBP for each trajectory subgroup was characterized at follow-up. Kaplan-Meier analysis for each trajectory group was also performed, and the relationship between the SBP trajectory and risk of stroke onset during follow-up was validated using a Cox proportional hazards model. Based on the SBP from 2015 to 2021, this cohort population was divided into three groups based on the trajectory development patterns: the low-stable group (37.6%), the moderate-increasing group (53.4%), and the high-acutely increasing group (9%). Gender, age, body mass index, diastolic blood pressure, and fasting blood glucose level were predictive factors for the SBP trajectory group. The cumulative survival risk in the high-acutely increasing group was higher than that of the other two groups. After adjusting for potential confounding factors and using the low-stable group as a reference, the hazard ratios (95% confidence interval) for the risk of stroke onset in the moderate-increasing and high-acutely increasing groups were 1.38 (0.91-2.07) and 1.51 (0.82-2.76), respectively. The results of the analysis demonstrate that higher blood pressure trajectories are associated with a higher risk of stroke and that the risk of stroke can be reduced by better control and management of the SBP.
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Xiaoxi Z, Xuan Z, Lei Z, Zifu L, Pengfei X, Hongjian S, Yongxin Z, Weilong H, Yihan Z, Dongwei D, Qiang L, Rui Z, Qinghai H, Yi X, Song L, Anderson CS, Jianmin L, Yongwei Z, Pengfei Y. Baseline blood pressure does not modify the effect of intravenous thrombolysis in successfully revascularized patients. Front Neurol 2022; 13:984599. [PMID: 36172030 PMCID: PMC9510834 DOI: 10.3389/fneur.2022.984599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundStudies indicate a trajectory relationship between baseline blood pressure (BP) and outcome in patients with acute ischemic stroke (AIS) eligible for both intravenous thrombolysis (IVT) with alteplase and endovascular treatment (EVT). We determined whether baseline BP modified the effect of IVT in successfully revascularized AIS patients who participated in the Direct Intra-Arterial Thrombectomy to Revascularize AIS Patients With Large Vessel Occlusion Efficiently in Chinese Tertiary Hospitals (DIECT-MT) trial.MethodsThe association of baseline systolic BP, trichotomized as high (141–185 mmHg), middle (121–140 mmHg), and low (91–120 mmHg), and the outcomes of any intracerebral hemorrhage (ICH), symptomatic ICH (sICH), and mortality and functional outcome on the modified Rankin scale at 90 days were explored. Logistic regression models determined the interaction between clinical outcomes and baseline systolic and diastolic BP, and mean arterial pressure (MAP), at 10 mmHg intervals. Data are reported as odds ratios (OR) and 95% CI.ResultsA post-hoc analysis of DIRECT-MT, in 510 of the 656 randomized participants with successful revascularization underwent MT. The overall adjusted common OR of IVT and baseline BP on any ICH, sICH, and 90-day mortality and functional outcome were 0.884 (95%CI 0.613–1.274), 0.643 (95%CI 0.283–1.458), 0.842 (95%CI 0.566–1.252), and 1.286 (95%CI 0.772–2.142), respectively. No significant interaction between baseline blood pressure and intravenous thrombolysis with clinical outcome was observed.ConclusionsIn patients with baseline SBP under 185 mmHg, baseline blood pressure does not alter the risk of hemorrhagic transformation and clinicaloutcome in successfully revascularized patients, regardless of intravenous alteplase usage. Future studies are needed to confirm our findings.RegistrationURL: http://www.clinicaltrials.gov, Identifier: NCT03469206.
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Affiliation(s)
- Zhang Xiaoxi
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zhu Xuan
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zhang Lei
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Li Zifu
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Xing Pengfei
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Shen Hongjian
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zhang Yongxin
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Hua Weilong
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zhou Yihan
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Dai Dongwei
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Li Qiang
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zhao Rui
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Huang Qinghai
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Xu Yi
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Lili Song
- Global Brain Health, The George Institute for Global Health, Beijing, China
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Craig S. Anderson
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Stroke Program, The George Institute for Global Health, Beijing, China
- Department of Neurology, Royal Prince Alfred Hospital, Sydney Health Partners, Sydney, NSW, Australia
| | - Liu Jianmin
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zhang Yongwei
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
- *Correspondence: Zhang Yongwei
| | - Yang Pengfei
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
- Yang Pengfei
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Chen X, Liu H, Ye H, Bian Z, Peng Y. Systolic blood pressure trajectories after acute ischemic strokes and clinical outcomes: A systematic review. J Clin Hypertens (Greenwich) 2022; 24:963-970. [PMID: 35894755 PMCID: PMC9380137 DOI: 10.1111/jch.14537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/07/2022] [Accepted: 06/13/2022] [Indexed: 11/28/2022]
Abstract
Blood pressure(BP) varies drastically during the acute phase after stroke onset. BP level and BP variability may have a major impact on acute ischemic stroke (AIS) prognosis. However, the association between trajectories of blood pressure over time and clinical outcomes have not been established. This review sought out existing evidences for associations of systolic blood pressure (SBP) trajectories on outcomes after stroke to determine the connection between SBP trajectories and stroke prognosis. According to a pre‐designed search strategy, literature search was carried out in Embase, Pubmed and Web of Science. Two authors independently evaluated study eligibility and quality, and literature data were extracted. When the literature was eligible, we perform meta‐analysis to determine associations of SBP trajectories with clinical outcomes. Seven studies were finally screened out of 52 studies retrieved. Seven studies received a good risk of bias rating and reported BP measurement methods and intervals, BP trajectories modeling methods, outcome measures, but it was found that final systolic BP trajectories in various papers were significantly different. All studies reported statistically significant associations between systolic blood pressure trajectories and prognosis. Methodological heterogeneity is observed in studies. However, this systematic review suggests that the high SBP group after AIS is related to poor clinical outcomes, while the rapid decline or medium‐to‐low or low SBP group is associated with relatively better clinical outcomes at different period after stroke. More prospective studies are needed to report the full methodology according to standardized criteria and explore relationships between SBP trajectories and prognosis of stroke.
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Affiliation(s)
- Xiuhua Chen
- Graduate School, North China University of Science and Technology, Tangshan, Hebei, China
| | - Huiliang Liu
- Graduate School, North China University of Science and Technology, Tangshan, Hebei, China
| | - Hongyuan Ye
- Department of Neurology, Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, China
| | - Zhe Bian
- Department of Neurology, Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, China
| | - Yanbo Peng
- Department of Neurology, Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, China
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Arling G, Perkins A, Myers LJ, Sico JJ, Bravata DM. Blood Pressure Trajectories and Outcomes for Veterans Presenting at VA Medical Centers with a Stroke or Transient Ischemic Attack. Am J Med 2022; 135:889-896.e1. [PMID: 35292287 DOI: 10.1016/j.amjmed.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/31/2022] [Accepted: 02/10/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Blood pressure control has been shown to reduce risk of vascular events and mortality after an ischemic stroke or transient ischemic attack (TIA). Yet, questions remain about effectiveness, timing, and targeted blood pressure reduction. METHODS We analyzed data from a retrospective cohort of 18,837 veterans cared for 12 months prior and up to 12 months after an emergency department visit or inpatient admission for stroke or TIA. Latent class growth analysis was used to classify patients into systolic blood pressure trajectories. With Cox proportional hazard models, we examined relationships between blood pressure trajectories, intensification of antihypertensive medication, and stroke (fatal or non-fatal) and all-cause mortality in 12 months following the index event. RESULTS The cohort was classified into 4 systolic blood pressure trajectories: 19% with a low systolic blood pressure trajectory (mean systolic blood pressure = 116 mm Hg); 65% with a medium systolic blood pressure trajectory (mean systolic blood pressure = 136 mm Hg); 15% with a high systolic blood pressure trajectory (mean systolic blood pressure = 158 mm Hg), and 1% with a very high trajectory (mean systolic blood pressure = 183 mm Hg). After the stroke or TIA, individuals in the high and very high systolic blood pressure trajectories experienced a substantial decrease in systolic blood pressure that coincided with intensification of antihypertensive medication. Patients with very low and very high systolic blood pressure trajectories had a significantly greater (P < .05) hazard of mortality, while medication intensification was related significantly (P < .05) to lower hazard of mortality. CONCLUSIONS These findings point to the importance of monitoring blood pressure over multiple time points and of instituting enhanced hypertension management after stroke or TIA, particularly for individuals with high or very high blood pressure trajectories.
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Affiliation(s)
- Greg Arling
- Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Precision Monitoring to Transform Care (PRISM) Quality Enhancement Research Initiative (QUERI), Washington, DC; School of Nursing, Purdue University, West Lafayette, Indianapolis, IN.
| | - Anthony Perkins
- Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Precision Monitoring to Transform Care (PRISM) Quality Enhancement Research Initiative (QUERI), Washington, DC; Biostatistics, Indiana University School of Medicine, Indianapolis, IN
| | - Laura J Myers
- Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Precision Monitoring to Transform Care (PRISM) Quality Enhancement Research Initiative (QUERI), Washington, DC; VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, Indianapolis, IN; Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN; Health Services Research, Regenstrief Institute, Indianapolis, IN
| | - Jason J Sico
- Neurology Service, VA Connecticut Healthcare System, West Haven, Conn; Department of Neurology, Yale School of Medicine, New Haven, Conn
| | - Dawn M Bravata
- Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Precision Monitoring to Transform Care (PRISM) Quality Enhancement Research Initiative (QUERI), Washington, DC; VA HSR&D Center for Health Information and Communication (CHIC), Richard L. Roudebush VA Medical Center, Indianapolis, IN; Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN; Health Services Research, Regenstrief Institute, Indianapolis, IN; Medicine Service, Richard L. Roudebush VA Medical Center, Indianapolis, IN
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9
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Tanaka K, Koga M, Fukuda-Doi M, Qureshi AI, Yamamoto H, Miwa K, Ihara M, Toyoda K. Temporal Trajectory of Systolic Blood Pressure and Outcomes in Acute Intracerebral Hemorrhage: ATACH-2 Trial Cohort. Stroke 2022; 53:1854-1862. [PMID: 35400202 PMCID: PMC9126256 DOI: 10.1161/strokeaha.121.037186] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 02/07/2022] [Accepted: 03/09/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND To highlight the heterogeneity of acute temporal blood pressure (BP) changes in the ATACH-2 trial (Antihypertensive Treatment of Acute Cerebral Hemorrhage-2) and associations with the outcomes of intracerebral hemorrhage. METHODS One thousand patients with acute intracerebral hemorrhage, who had been randomized to intensive (110-139 mm Hg) or standard (140-179 mm Hg) systolic BP (SBP) lowering with intravenous nicardipine in ATACH-2 from 2011 to 2015, were analyzed about temporal changes in hourly maximum SBP up to 24 hours after randomization using group-based trajectory modeling. Outcomes included death or disability (modified Rankin Scale score 4-6) at 3 months, neurological deterioration within 24 hours (≥2-point decrease in Glasgow Coma Scale score or ≥4-point increase in National Institutes of Health Stroke Scale score), and acute kidney injury (≥0.3 mg/dL within 48 hours or ≥1.5-fold increase in serum creatinine) within 7 days after onset. RESULTS Group-based trajectory modeling revealed 4 SBP trajectory groups: moderate SBP (from ≈190 mm Hg at hospital arrival to 150-160 mm Hg after randomization; n=298), moderate-to-low SBP (from ≈190 mm Hg to <140 mm Hg; n=395), high-to-low SBP (from >210 mm Hg to <140 mm Hg; n=134), and high SBP (from >210 mm Hg to 160-170 mm Hg; n=173). Patients with intensive treatment accounted for 11.1%, 88.6%, 85.1%, and 1.7% of each group, respectively. Compared with the moderate-to-low SBP group, the high-to-low SBP group showed increased risks of death or disability at 3 months (adjusted odds ratio, 2.29 [95% CI, 1.24-4.26]) and acute kidney injury (adjusted odds ratio, 3.50 [95% CI, 1.83-6.69]), while no increase in neurological deterioration was seen in this group (adjusted odds ratio, 0.48 [95% CI, 0.20-1.13]). The moderate SBP and high SBP groups showed no significant risk differences for such outcomes. CONCLUSIONS Data-driven observation using a group-based trajectory modeling approach may be useful to clarify the relationship between antihypertensive treatment, temporal SBP changes, and outcomes in acute intracerebral hemorrhage. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT01176565.
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Affiliation(s)
- Kanta Tanaka
- Department of Cerebrovascular Medicine (K. Tanaka, M.K., M.F.-D., K.M., K. Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine (K. Tanaka, M.K., M.F.-D., K.M., K. Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Mayumi Fukuda-Doi
- Department of Cerebrovascular Medicine (K. Tanaka, M.K., M.F.-D., K.M., K. Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan
- Department of Data Science (M.F.-D., H.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Adnan I. Qureshi
- Zeenat Qureshi Stroke Research Center, University of Minnesota, Mineapolis (A.I.Q.)
| | - Haruko Yamamoto
- Department of Data Science (M.F.-D., H.Y.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kaori Miwa
- Department of Cerebrovascular Medicine (K. Tanaka, M.K., M.F.-D., K.M., K. Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masafumi Ihara
- Department of Neurology (M.I.), National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine (K. Tanaka, M.K., M.F.-D., K.M., K. Toyoda), National Cerebral and Cardiovascular Center, Suita, Japan
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10
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Lee KJ, Kim BJ, Han MK, Kim JT, Choi KH, Shin DI, Cha JK, Kim DH, Kim DE, Ryu WS, Park JM, Kang K, Lee SJ, Oh MS, Yu KH, Lee BC, Hong KS, Cho YJ, Choi JC, Park TH, Park SS, Kwon JH, Kim WJ, Lee J, Sohn SI, Hong JH, Lee KB, Lee JS, Lee J, Gorelick PB, Bae HJ. One-Year Blood Pressure Trajectory After Acute Ischemic Stroke. J Am Heart Assoc 2022; 11:e023747. [PMID: 35195014 PMCID: PMC9075074 DOI: 10.1161/jaha.121.023747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Although the effect of blood pressure on poststroke outcome is well recognized, the long-term trajectory of blood pressure after acute ischemic stroke and its influence on outcomes have not been studied well. Methods and Results We analyzed systolic blood pressure (SBP) measurements in 5514 patients with acute ischemic stroke at ≥2 of 7 prespecified time points during the first year after stroke among those enrolled in a multicenter prospective registry. Longitudinal SBPs were categorized using a group-based trajectory model. The primary outcome was a composite of stroke recurrence, myocardial infarction, and all-cause mortality up to 1 year after stroke. The study subjects were categorized into 4 SBP trajectory groups: low (27.0%), moderate (59.5%), persistently high (1.2%), and slowly dropping (12.4%). In the first 3 groups, SBP decreased during the first 3 to 7 days and remained steady thereafter. In the slowly dropping SBP group, SBPs decreased from 182 to 135 mm Hg during the first 30 days, then paralleled the trajectory of the moderate SBP group. Compared with the reference, the moderate SBP group, the slowly dropping SBP group was at higher risk for the primary outcome (adjusted hazard ratio [HR], 1.32; 95% CI, 1.05‒1.65) and mortality (adjusted HR, 1.35; 95% CI, 1.03‒1.78). Primary outcome rates were similarly high in the persistently high SBP group. Conclusions Four 1-year longitudinal SBP trajectories were identified in patients with acute ischemic stroke. Patients in the slowly dropping SBP and persistently high SBP trajectory groups were prone to adverse cardiovascular outcomes after stroke.
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Affiliation(s)
- Keon-Joo Lee
- Department of Neurology Seoul National University Bundang Hospital Seongnam Korea.,Department of Neurology Korea University Guro Hospital Seoul Korea
| | - Beom Joon Kim
- Department of Neurology Seoul National University Bundang Hospital Seongnam Korea
| | - Moon-Ku Han
- Department of Neurology Seoul National University Bundang Hospital Seongnam Korea
| | - Joon-Tae Kim
- Department of Neurology Chonnam National University Hospital Gwangju Korea
| | - Kang Ho Choi
- Department of Neurology Chonnam National University Hospital Gwangju Korea
| | - Dong-Ick Shin
- Department of Neurology Chungbuk National University Hospital Cheongju Korea
| | - Jae-Kwan Cha
- Department of Neurology Dong-A University Hospital Busan Korea
| | - Dae-Hyun Kim
- Department of Neurology Dong-A University Hospital Busan Korea
| | - Dong-Eog Kim
- Department of Neurology Dongguk University Ilsan Hospital Goyang Korea
| | - Wi-Sun Ryu
- Department of Neurology Dongguk University Ilsan Hospital Goyang Korea
| | - Jong-Moo Park
- Department of Neurology Uijeongbu Eulji Medical CenterEulji University Seoul Korea
| | - Kyusik Kang
- Department of Neurology Nowon Eulji Medical CenterEulji University Seoul Korea
| | - Soo Joo Lee
- Department of Neurology Eulji University Hospital Daejeon Korea
| | - Mi-Sun Oh
- Department of Neurology Hallym University Sacred Heart Hospital Anyang Korea
| | - Kyung-Ho Yu
- Department of Neurology Hallym University Sacred Heart Hospital Anyang Korea
| | - Byung-Chul Lee
- Department of Neurology Hallym University Sacred Heart Hospital Anyang Korea
| | - Keun-Sik Hong
- Department of Neurology Inje University Ilsan Paik Hospital Goyang Korea
| | - Yong-Jin Cho
- Department of Neurology Inje University Ilsan Paik Hospital Goyang Korea
| | - Jay Chol Choi
- Department of Neurology Jeju National University Hospital Jeju Korea
| | - Tai Hwan Park
- Department of Neurology Seoul Medical Center Seoul Korea
| | - Sang-Soon Park
- Department of Neurology Seoul Medical Center Seoul Korea
| | - Jee-Hyun Kwon
- Department of Neurology Ulsan University Hospital Ulsan Korea
| | - Wook-Joo Kim
- Department of Neurology Ulsan University Hospital Ulsan Korea
| | - Jun Lee
- Department of Neurology Yeungnam University Medical Center Daegu Korea
| | - Sung Il Sohn
- Department of Neurology Keimyung University Dongsan Medical Center Daegu Korea
| | - Jeong-Ho Hong
- Department of Neurology Keimyung University Dongsan Medical Center Daegu Korea
| | - Kyung Bok Lee
- Department of Neurology Soonchunhyang University Hospital Seoul Korea
| | - Ji Sung Lee
- Clinical Research Center Asan Medical Center Seoul Korea
| | - Juneyoung Lee
- Department of Biostatistics Korea University Seoul Korea
| | - Philip B Gorelick
- Davee Department of Neurology Feinberg School of MedicineNorthwestern University Chicago IL.,Department of Translational Neuroscience Michigan State UniversityCollege of Human Medicine Grand Rapids MI
| | - Hee-Joon Bae
- Department of Neurology Seoul National University Bundang Hospital Seongnam Korea
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11
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Zhou H, Zhang H, Zhan Q, Bai Y, Liu S, Yang X, Li J, Ma Z, Huang X, Zeng Q, Ren H, Xu D. Blood pressure trajectories in early adulthood and myocardial structure and function in later life. ESC Heart Fail 2022; 9:1258-1268. [PMID: 35049140 PMCID: PMC8934963 DOI: 10.1002/ehf2.13803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/24/2021] [Accepted: 12/28/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Haobin Zhou
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital Southern Medical University 1838 North Guangzhou Avenue Guangzhou Guangdong 510515 China
| | - Hao Zhang
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital Southern Medical University 1838 North Guangzhou Avenue Guangzhou Guangdong 510515 China
| | - Qiong Zhan
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital Southern Medical University 1838 North Guangzhou Avenue Guangzhou Guangdong 510515 China
| | - Yujia Bai
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital Southern Medical University 1838 North Guangzhou Avenue Guangzhou Guangdong 510515 China
| | - Shenrong Liu
- Department of Cardiac Pediatrics, Guangdong Cardiovascular Institute Guangdong Academy of Medical Sciences/Guangdong General Hospital Guangzhou China
| | - Xi Yang
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital Southern Medical University 1838 North Guangzhou Avenue Guangzhou Guangdong 510515 China
| | - Jiaying Li
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital Southern Medical University 1838 North Guangzhou Avenue Guangzhou Guangdong 510515 China
| | - Zhuang Ma
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital Southern Medical University 1838 North Guangzhou Avenue Guangzhou Guangdong 510515 China
| | - Xingfu Huang
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital Southern Medical University 1838 North Guangzhou Avenue Guangzhou Guangdong 510515 China
| | - Qingchun Zeng
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital Southern Medical University 1838 North Guangzhou Avenue Guangzhou Guangdong 510515 China
| | - Hao Ren
- Department of Rheumatology, Nanfang Hospital Southern Medical University 1838 Northern Guangzhou Avenue Guangzhou Guangdong 510515 China
| | - Dingli Xu
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital Southern Medical University 1838 North Guangzhou Avenue Guangzhou Guangdong 510515 China
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12
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Tanaka K, Koga M, Lee KJ, Kim BJ, Mizoguchi T, Park EL, Lee J, Yoshimura S, Cha JK, Lee BC, Koge J, Bae HJ, Toyoda K. Transesophageal Echocardiography in Ischemic Stroke With Atrial Fibrillation. J Am Heart Assoc 2021; 10:e022242. [PMID: 34743551 PMCID: PMC8751927 DOI: 10.1161/jaha.121.022242] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background To clarify differences in clinical significance of intracardiac thrombi in nonvalvular atrial fibrillation‐associated stroke as identified by transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE). Methods and Results Using patient data on nonvalvular atrial fibrillation‐associated ischemic stroke between 2011 and 2014 from 15 South Korean stroke centers (n=4841) and 18 Japanese centers (n=1192), implementation rates of TEE/TTE, and detection rates of intracardiac thrombi at each center were correlated. The primary outcome was recurrent ischemic stroke at 1 year after the onset. A total of 5648 patients (median age, 75 years; 2650 women) were analyzed. Intracardiac thrombi were detected in 75 patients (1.3%) overall. Thrombi were detected in 7.8% of patients with TEE (either TEE alone or TEE+TTE: n=679) and in 0.6% of those with TTE alone (n=3572). Thrombus detection rates varied between 0% and 14.3% among centers. As TEE implementation rates at each center increased from 0% to 56.7%, thrombus detection rates increased linearly (detection rate [%]=0.11×TEE rate [%]+1.09 [linear regression], P<0.01). TTE implementation rates (32.3%–100%) were not associated with thrombus detection rates (P=0.53). Intracardiac thrombi were associated with risk of recurrent ischemic stroke overall (adjusted hazard ratio [aHR] 2.35, 95% CI, 1.07–5.16). Thrombus‐associated ischemic stroke risk was high in patients with TEE (aHR, 3.13; 95% CI, 1.17–8.35), but not in those with TTE alone (aHR, 0.89; 95% CI, 0.12–6.51). Conclusions Our data suggest clinical relevance of TEE for accurate detection and risk stratification of intracardiac thrombi in nonvalvular atrial fibrillation‐associated stroke. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01581502.
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Affiliation(s)
- Kanta Tanaka
- Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita Japan
| | - Keon-Joo Lee
- Department of Neurology Cerebrovascular Center Seoul National University Bundang Hospital Seongnam-si South Korea
| | - Beom Joon Kim
- Department of Neurology Cerebrovascular Center Seoul National University Bundang Hospital Seongnam-si South Korea
| | - Tadataka Mizoguchi
- Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita Japan
| | - Eun Lyeong Park
- Department of Biostatistics College of Medicine Korea University Seoul South Korea
| | - Juneyoung Lee
- Department of Biostatistics College of Medicine Korea University Seoul South Korea
| | - Sohei Yoshimura
- Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita Japan
| | - Jae-Kwan Cha
- Department of Neurology Dong-A University Hospital Busan Korea
| | - Byung-Chul Lee
- Department of Neurology Hallym University Sacred Heart Hospital Anyang Korea
| | - Junpei Koge
- Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita Japan
| | - Hee-Joon Bae
- Department of Neurology Cerebrovascular Center Seoul National University Bundang Hospital Seongnam-si South Korea
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine National Cerebral and Cardiovascular Center Suita Japan
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13
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Kim BJ, Singh N, Menon BK. Hemodynamics of Leptomeningeal Collaterals after Large Vessel Occlusion and Blood Pressure Management with Endovascular Treatment. J Stroke 2021; 23:343-357. [PMID: 34649379 PMCID: PMC8521259 DOI: 10.5853/jos.2021.02446] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/03/2021] [Accepted: 09/09/2021] [Indexed: 12/14/2022] Open
Abstract
Endovascular therapy (EVT) is an effective treatment for ischemic stroke due to large vessel occlusion (LVO). Unlike intravenous thrombolysis, EVT enables visualization of the restoration of blood flow, also known as successful reperfusion in real time. However, until successful reperfusion is achieved, the survival of the ischemic brain is mainly dependent on blood flow from the leptomeningeal collaterals (LMC). It plays a critical role in maintaining tissue perfusion after LVO via pre-existing channels between the arborizing pial small arteries or arterioles overlying the cerebral hemispheres. In the ischemic territory where the physiologic cerebral autoregulation is impaired and the pial arteries are maximally dilated within their capacity, the direction and amount of LMC perfusion rely on the systemic perfusion, which can be estimated by measuring blood pressure (BP). After the EVT procedure, treatment focuses on mitigating the risk of hemorrhagic transformation, potentially via BP reduction. Thus, BP management may be a key component of acute care for patients with LVO stroke. However, the guidelines on BP management during and after EVT are limited, mostly due to the scarcity of high-level evidence on this issue. In this review, we aim to summarize the anatomical and physiological characteristics of LMC to maintain cerebral perfusion after acute LVO, along with a landscape summary of the literature on BP management in endovascular treatment. The objective of this review is to describe the mechanistic association between systemic BP and collateral perfusion after LVO and thus provide clinical and research perspectives on this topic.
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Affiliation(s)
- Beom Joon Kim
- Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Nishita Singh
- Department of Clinical Neurosciences, Foothills Medical Center, University of Calgary, Calgary, AB, Canada
| | - Bijoy K. Menon
- Department of Clinical Neurosciences, Foothills Medical Center, University of Calgary, Calgary, AB, Canada
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14
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Fan K, Zhao J, Chang H, Wang X, Yao H, Yao X, Yang X. Predicting prognosis in patients with stroke treated with intravenous alteplase through the 24-h trajectory of blood pressure changes. J Clin Hypertens (Greenwich) 2021; 23:1718-1730. [PMID: 34347363 PMCID: PMC8678769 DOI: 10.1111/jch.14331] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 12/05/2022]
Abstract
Blood pressure (BP) monitored within 24 h from the beginning of intravenous thrombolysis (IVT) with alteplase, is one of the important factors affecting the prognosis of patients with acute ischemic stroke (AIS). This study aimed to explore longitudinal BP trajectory patterns and determine their association with stroke prognosis after thrombolysis. From November 2018 to September 2019, a total of 391 patients were enrolled consecutively during the study period, and 353 patients were ultimately analyzed. Five systolic (SBP) and four diastolic blood pressure (DBP) trajectory subgroups were identified. The regression analysis showed that when compared with the rapidly moderate stable group, the continuous fluctuation‐very high level SBP group (odds ratio [OR]: 2.743, 95% confidence interval [CI]: 1.008–7.467) was associated with early neurological deterioration (END). Both the rapid drop‐high level SBP (OR: 0.448, 95% CI: 0.219–0.919) and DBP groups (OR: 0.399, 95% CI: 0.219–0.727) were associated with early neurological improvement (ENI). Moreover, there was a U‐shaped correlation between the OR value of SBP trajectory group and favorable outcome (the modified Rankin Scale [mRS] score 0–2) at 3 months: the slow drop‐low level SBP group represent a well‐established unfavorable outcome risk factor (OR:5.239, 95% CI: 1.271–21.595), and extremely high SBP—the continuous fluctuation‐very high level SBP group, are equally associated with elevated unfavorable outcome risk (OR:3.797, 95% CI: 1.486–9.697). The continuous fluctuation‐very high level DBP group was statistically significant in mRS (OR: 3.387, CI: 1.185–9.683). The BP trajectory groups show varying clinical features and risk of neurological dysfunction. The findings may help identify potential candidates for clinical BP monitoring, control, and specialized care.
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Affiliation(s)
- Kaiting Fan
- Department of Neurology, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatic Disease, Beijing, China
| | - Jie Zhao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatic Disease, Beijing, China
| | - Hong Chang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatic Disease, Beijing, China
| | - Xiaojuan Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatic Disease, Beijing, China
| | - Hui Yao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatic Disease, Beijing, China
| | - Xiaoxia Yao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatic Disease, Beijing, China
| | - Xin Yang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatic Disease, Beijing, China
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15
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Lattanzi S, Divani AA, Silvestrini M. Blood pressure trajectories after stroke: Do they matter? J Clin Hypertens (Greenwich) 2021; 23:1731-1733. [PMID: 34297891 PMCID: PMC8678677 DOI: 10.1111/jch.14330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 07/11/2021] [Accepted: 07/12/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Afshin A Divani
- Department of Neurology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Mauro Silvestrini
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
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16
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Cheng G, He S, He Q, Xie X, Tang C, Xie Q, Wu X, Jiang N, Li C, Min X, Yan Y. Trajectory patterns of blood pressure change up to six years and the risk of dementia: a nationwide cohort study. Aging (Albany NY) 2021; 13:17380-17406. [PMID: 34198262 PMCID: PMC8312414 DOI: 10.18632/aging.203228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/08/2021] [Indexed: 11/25/2022]
Abstract
The present study aimed to investigate the associations between the trajectory of blood pressure (BP) change and the risk of subsequent dementia and to explore the differences in age, gender, and hypertension subgroups. We included 10,660 participants aged ≥ 60 years from 1998 to 2018 waves of the Chinese Longitudinal Healthy Longevity Survey. Latent growth mixture models were used to estimate BP trajectories. Cox-proportional hazard models were used to analyze the effects of BP trajectories on the risk of dementia. According to the results, stabilized systolic BP (SBP) was found to be associated with a higher risk of dementia compared with normal SBP [adjusted hazard ratio (aHR): 1.62; 95% confidence interval (CI): 1.27-2.07] and elevated SBP (aHR: 2.22; 95% CI: 1.51-3.28) in and only in the subgroups of the oldest-old, women, and subjects without hypertension at baseline. Similarly, stabilized pulse pressure (PP) was associated with a higher risk of dementia compared with normal PP (aHR: 1.52; 95% CI: 1.24-1.88) and elevated PP (aHR: 2.12; 95% CI: 1.48-3.04) in and only in the subgroups of the oldest-old, women, and subjects with hypertension at baseline. These findings suggest that stabilized SBP and PP have predictive significance for the occurrence of dementia in late life, and the factors of age, gender, and late-life hypertension should be considered when estimating the risk of BP decline on dementia.
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Affiliation(s)
- Gang Cheng
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Simin He
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Qiong He
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Xiaowei Xie
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Cai Tang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Qunhui Xie
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Xihong Wu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Ni Jiang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Chao Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Xianying Min
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Yan Yan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
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17
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Recurrent Ischemic and Hemorrhagic Stroke in Cameroon: A Case-Control Study. Neurol Res Int 2021; 2021:9948990. [PMID: 34221504 PMCID: PMC8221891 DOI: 10.1155/2021/9948990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/22/2021] [Accepted: 06/09/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction Stroke recurrence accounts for a great percentage of catastrophic complications, yet no comprehensive study has analyzed the factors associated with stroke recurrence in Cameroon. We carried out this case-control study to better understand the factors associated with the stroke recurrence in Cameroon. Methods We collected sociodemographic, clinical, neuroimaging, laboratory, and therapeutic data of eligible patients who consulted the neurology and cardiology department of the Yaounde Central Hospital in Cameroon. We included all patients at least five years removed from their first stroke event who consulted the authors' institution as of January 15, 2019. Wilcoxon signed-rank and Fisher's exact tests were used. Also, a Cox regression model was used to identify confounders. Results We recruited 100 patients; seven out of ten patients had hypertension, while six out of 10 had a sedentary lifestyle. Half of the patients consumed alcohol regularly, while one patient out of five had diabetes. Most patients presented with their first stroke event, and a quarter had a stroke recurrence. Stroke recurrence was associated with right handedness (OR = 0.23, 95% CI = 0.16–0.33), congestive heart failure (OR = 3.45, 95% CI = 1.16–10.28), gout (OR = 4.34, 95% CI = 1.09–18.09), dysarthria (OR = 4.34, 95% CI = 1.30–14.54), and facial palsy (OR = 3.96, 95% CII = 1.49 – 10.51), as well as modifiable factors such as elevated abdominal circumference (P < 0.01), systolic blood pressure (P < 0.01), blood glucose level (PI <I 0.01), LDL cholesterol (P < 0.01), and triglyceride levels (P < 0.01). The mulitvariable regression model only identified laterality (B = –1.48, P = 0.04) as a statistically significant explanatory varibale for stroke recurrence. Conclusion We mapped the landscape of recurrent strokes in Cameroon. There is a need to evaluate the causes of suboptimal drug adherence rates and both the role and adherence to nonpharmacologic interventions.
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Kim BJ, Cho YJ, Hong KS, Lee J, Kim JT, Choi KH, Park TH, Park SS, Park JM, Kang K, Lee SJ, Kim JG, Cha JK, Kim DH, Lee BC, Yu KH, Oh MS, Kim DE, Ryu WS, Choi JC, Kim WJ, Shin DI, Sohn SI, Hong JH, Lee JS, Lee J, Han MK, Gorelick PB, Bae HJ. Treatment Intensification for Elevated Blood Pressure and Risk of Recurrent Stroke. J Am Heart Assoc 2021; 10:e019457. [PMID: 33787300 PMCID: PMC8174371 DOI: 10.1161/jaha.120.019457] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background It remains unclear whether physicians' attitudes toward timely management of elevated blood pressure affect the risk of stroke recurrence. Methods and Results From a multicenter stroke registry database, we identified 2933 patients with acute ischemic stroke who were admitted to participating centers in 2011, survived at the 1‐year follow‐up period, and returned to outpatient clinics ≥2 times after discharge. As a surrogate measure of physicians' attitude, individual treatment intensification (TI) scores were calculated by dividing the difference between the frequencies of observed and expected medication changes by the frequency of clinic visits and categorizing them into 5 groups. The association between TI groups and the recurrence of stroke within 1 year was analyzed using hierarchical frailty models, with adjustment for clustering within each hospital and relevant covariates. Mean±SD of the TI score was −0.13±0.28. The TI score groups were significantly associated with increased risk of recurrent stroke compared with Group 3 (TI score range, −0.25 to 0); Group 1 (range, −1 to −0.5), adjusted hazard ratio (HR) 13.43 (95% CI, 5.95–30.35); Group 2 (range, −0.5 to −0.25), adjusted HR 4.59 (95% CI, 2.01–10.46); and Group 4 (TI score 0), adjusted HR 6.60 (95% CI, 3.02–14.45); but not with Group 5 (range, 0–1), adjusted HR 1.68 (95% CI, 0.62–4.56). This elevated risk in the lowest TI score groups persisted when confining analysis to those with hypertension, history of blood pressure‐lowering medication, no atrial fibrillation, and regular clinic visits and stratifying the subjects by functional capacity at discharge. Conclusions A low TI score, which implies physicians' therapeutic inertia in blood pressure management, was associated with a higher risk of recurrent stroke. The TI score may be a useful performance indicator in the outpatient clinic setting to prevent recurrent stroke.
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Affiliation(s)
- Beom Joon Kim
- Department of Neurology and Cerebrovascular Center Seoul National University Bundang HospitalSeoul National University College of Medicine Seongnam Republic of Korea
| | - Yong-Jin Cho
- Department of Neurology Ilsan Paik HospitalInje University Goyang Republic of Korea
| | - Keun-Sik Hong
- Department of Neurology Ilsan Paik HospitalInje University Goyang Republic of Korea
| | - Jun Lee
- Department of Neurology Yeungnam University Hospital Daegu Republic of Korea
| | - Joon-Tae Kim
- Department of Neurology Chonnam National University Medical School and Hospital Gwangju Republic of Korea
| | - Kang Ho Choi
- Department of Neurology Chonnam National University Medical School and Hospital Gwangju Republic of Korea
| | - Tai Hwan Park
- Department of Neurology Seoul Medical Center Seoul Republic of Korea
| | - Sang-Soon Park
- Department of Neurology Seoul Medical Center Seoul Republic of Korea
| | - Jong-Moo Park
- Department of Neurology Eulji General Hospital Eulji University Seoul Republic of Korea
| | - Kyusik Kang
- Department of Neurology Eulji General Hospital Eulji University Seoul Republic of Korea
| | - Soo Joo Lee
- Department of Neurology Eulji University HospitalEulji University Daejeon Republic of Korea
| | - Jae Guk Kim
- Department of Neurology Eulji University HospitalEulji University Daejeon Republic of Korea
| | - Jae-Kwan Cha
- Department of Neurology Dong-A University College of Medicine Busan Republic of Korea
| | - Dae-Hyun Kim
- Department of Neurology Dong-A University College of Medicine Busan Republic of Korea
| | - Byung-Chul Lee
- Department of Neurology Hallym University Sacred Heart Hospital Anyang Republic of Korea
| | - Kyung-Ho Yu
- Department of Neurology Hallym University Sacred Heart Hospital Anyang Republic of Korea
| | - Mi-Sun Oh
- Department of Neurology Hallym University Sacred Heart Hospital Anyang Republic of Korea
| | - Dong-Eog Kim
- Department of Neurology Dongguk University Ilsan Hospital Goyang Republic of Korea
| | - Wi-Sun Ryu
- Department of Neurology Dongguk University Ilsan Hospital Goyang Republic of Korea
| | - Jay Chol Choi
- Department of Neurology Jeju National University Jeju Republic of Korea
| | - Wook-Joo Kim
- Department of Neurology Ulsan University HospitalUniversity of Ulsan College of Medicine Ulsan Republic of Korea
| | - Dong-Ick Shin
- Department of Neurology Chungbuk National University Hospital Cheongju Republic of Korea
| | - Sung Il Sohn
- Department of Neurology Keimyung University Dongsan Medical Center Daegu Republic of Korea
| | - Jeong-Ho Hong
- Department of Neurology Keimyung University Dongsan Medical Center Daegu Republic of Korea
| | - Ji Sung Lee
- Clinical Research Center Asan Medical Center Seoul Republic of Korea
| | - Juneyoung Lee
- Department of Biostatistics College of Medicine Korea University Seoul Republic of Korea
| | - Moon-Ku Han
- Department of Neurology and Cerebrovascular Center Seoul National University Bundang HospitalSeoul National University College of Medicine Seongnam Republic of Korea
| | - Philip B Gorelick
- Davee Department of Neurology Northwestern University Feinberg School of Medicine Chicago IL
| | - Hee-Joon Bae
- Department of Neurology and Cerebrovascular Center Seoul National University Bundang HospitalSeoul National University College of Medicine Seongnam Republic of Korea
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Zheng X, Peng Y, Zhong C, Xie X, Wang A, Zhu Z, Xu T, Peng H, Xu T, Wang D, Ju Z, Geng D, Chen J, Liu L, He J, Zhang Y. Systolic Blood Pressure Trajectories After Discharge and Long-Term Clinical Outcomes of Ischemic Stroke. Hypertension 2021; 77:1694-1702. [PMID: 33745302 DOI: 10.1161/hypertensionaha.120.16881] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Xiaowei Zheng
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China (X.Z., C.Z., A.W., Z.Z., T.X., H.P., T.X., Y.Z.).,Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (X.Z., J.C., J.H.)
| | - Yanbo Peng
- Department of Neurology, Affiliated Hospital of North China University of Science and Technology, Tangshan (Y.P., D.W.)
| | - Chongke Zhong
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China (X.Z., C.Z., A.W., Z.Z., T.X., H.P., T.X., Y.Z.)
| | - Xuewei Xie
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (X.X., L.L.)
| | - Aili Wang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China (X.Z., C.Z., A.W., Z.Z., T.X., H.P., T.X., Y.Z.)
| | - Zhengbao Zhu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China (X.Z., C.Z., A.W., Z.Z., T.X., H.P., T.X., Y.Z.)
| | - Tan Xu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China (X.Z., C.Z., A.W., Z.Z., T.X., H.P., T.X., Y.Z.).,Department of Neurology, Affiliated Hospital of Nantong University, China (T.X.)
| | - Hao Peng
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China (X.Z., C.Z., A.W., Z.Z., T.X., H.P., T.X., Y.Z.)
| | - Tian Xu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China (X.Z., C.Z., A.W., Z.Z., T.X., H.P., T.X., Y.Z.).,Department of Neurology, Affiliated Hospital of Nantong University, China (T.X.)
| | - Dali Wang
- Department of Neurology, Affiliated Hospital of North China University of Science and Technology, Tangshan (Y.P., D.W.)
| | - Zhong Ju
- Department of Neurology, Kerqin District First People's Hospital of Tongliao City, China (Z.J.)
| | - Deqin Geng
- Department of Neurology, Affiliated Hospital of Xuzhou Medical University, China (D.G.)
| | - Jing Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (X.Z., J.C., J.H.).,Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C., J.H.)
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (X.X., L.L.)
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (X.Z., J.C., J.H.).,Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C., J.H.)
| | - Yonghong Zhang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China (X.Z., C.Z., A.W., Z.Z., T.X., H.P., T.X., Y.Z.)
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20
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Abstract
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.
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Affiliation(s)
- Philip B Gorelick
- From the Division of Stroke and Neurocritical Care, Davee Department of Neurology (P.B.G.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Paul K Whelton
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, Tulane University of Medicine, New Orleans, LA (P.K.W.)
| | - Farzaneh Sorond
- Davee Department of Neurology (F.S.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Robert M Carey
- Division of Endocrinology and Metabolism, Department of Medicine, Dean Emeritus, School of Medicine, University of Virginia Health System, Charlottesville (R.M.C.)
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21
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Jiang C, Wang T, Xu YC, Gao Y, Fang BJ. A retrospective study of Yiqi-Huoxue Decoction on blood pressure in patients with acute ischemic stroke. Medicine (Baltimore) 2020; 99:e23187. [PMID: 33235079 PMCID: PMC7710200 DOI: 10.1097/md.0000000000023187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
This retrospective study investigated the effect of Yiqi-Huoxue Decoction (YQHXD) on blood pressure (BP) in patients with acute ischemic stroke (AIS).A total of 72 patients with BP following AIS who received routine treatment were included in this retrospective study. Of those, 36 patients received YQHXD and were assigned to a treatment group. The other 36 patients were allocated to a control group. All patients were treated for a total of 4 months. The outcomes were assessed by systolic blood pressure (SBP), diastolic blood pressure (DBP), National Institutes of Health Stroke Scale (NIHSS) score and Barthel index scale (BIS). All outcomes were measured after 4-month treatment.After treatment, all subjects in the treatment group showed greater improvements in SBP (P < .05), DBP (P < .05), NIHSS (P < .05) score, and BIS (P < .05) than those of patients in the control group. In addition, the safety profile is similar in both groups.The findings of this study demonstrated that YQHXD may benefit on BP in patients with AIS. Future studies should focus on warranting the current results.
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Affiliation(s)
- Chao Jiang
- The Third Department of Neurology, The Second Affiliated Hospital of Xi’an Medical University, Xi’an, Shaanxi
- Department of Emergency, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai
| | - Ting Wang
- School of Economics and Management, Xidian University, Xi’an
| | - Yong-Cheng Xu
- Department of Vascular Diseases, Shanghai Traditional Chinese Medicine Integrated Hospital, Shanghai, China
| | - Ying Gao
- The Third Department of Neurology, The Second Affiliated Hospital of Xi’an Medical University, Xi’an, Shaanxi
| | - Bang-Jiang Fang
- Department of Emergency, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai
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22
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Shin JA, Lee KJ, Lee JS, Kang J, Kim BJ, Han MK, Kim JY, Jang MS, Yang MH, Lee J, Gorelick PB, Bae HJ. Relationship between blood pressure and outcome changes over time in acute ischemic stroke. Neurology 2020; 95:e1362-e1371. [PMID: 32641533 DOI: 10.1212/wnl.0000000000010203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 03/16/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate whether the relationship between systolic blood pressure (SBP) and stroke outcome varies during the acute stage of ischemic stroke as a function of the elapsed time after stroke onset. METHODS Patients who were hospitalized due to ischemic stroke within 6 hours of onset were retrospectively analyzed. SBP data were collected at 8 time points (1, 2, 4, 8, 16, 24, 48, and 72 hours after onset). The primary functional outcome measure was a poor outcome, defined as a modified Rankin Scale score of >2 at 3 months after stroke. Linear and quadratic models were constructed at each time point to assess relationships between SBP and outcome. RESULTS Of the 2,546 patients, 728 (28.6%) had a poor outcome. SBP, as either a linear or quadratic term, had a significant effect on functional outcome, except at 4 hours after onset. For the initial 2 hours after onset, SBP had nonlinear U-shaped relationships with functional outcome, and patients with SBP of approximately 165 mm Hg were the least likely to have a poor outcome. Quadratic models exhibited a significantly better model fit. For 8-24 hours postonset, SBP exhibited linear relationships with functional outcome. For 48-72 hours postonset, SBP exhibited a J-shaped relationship with functional outcome, and the predicted probability of poor outcome was the lowest in patients with SBP of approximately 125 mm Hg. These relationships were relatively consistent across various sensitivity analyses. CONCLUSION This study revealed that the relationship between SBP and functional outcome may depend on elapsed time from stroke onset.
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Affiliation(s)
- Ji-Ah Shin
- From the Seoul National University College of Medicine (J.-A.S.); Department of Neurology, Cerebrovascular Center (K.-J.L., J.K., B.J.K., M.-K.H., J.Y.K., M.S.J., M.H.Y., H.-J.B.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Biostatistics (J.L.), Korea University, Seoul; and Davee Department of Neurology (P.B.G.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Keon-Joo Lee
- From the Seoul National University College of Medicine (J.-A.S.); Department of Neurology, Cerebrovascular Center (K.-J.L., J.K., B.J.K., M.-K.H., J.Y.K., M.S.J., M.H.Y., H.-J.B.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Biostatistics (J.L.), Korea University, Seoul; and Davee Department of Neurology (P.B.G.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ji Sung Lee
- From the Seoul National University College of Medicine (J.-A.S.); Department of Neurology, Cerebrovascular Center (K.-J.L., J.K., B.J.K., M.-K.H., J.Y.K., M.S.J., M.H.Y., H.-J.B.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Biostatistics (J.L.), Korea University, Seoul; and Davee Department of Neurology (P.B.G.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jihoon Kang
- From the Seoul National University College of Medicine (J.-A.S.); Department of Neurology, Cerebrovascular Center (K.-J.L., J.K., B.J.K., M.-K.H., J.Y.K., M.S.J., M.H.Y., H.-J.B.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Biostatistics (J.L.), Korea University, Seoul; and Davee Department of Neurology (P.B.G.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Beom Joon Kim
- From the Seoul National University College of Medicine (J.-A.S.); Department of Neurology, Cerebrovascular Center (K.-J.L., J.K., B.J.K., M.-K.H., J.Y.K., M.S.J., M.H.Y., H.-J.B.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Biostatistics (J.L.), Korea University, Seoul; and Davee Department of Neurology (P.B.G.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Moon-Ku Han
- From the Seoul National University College of Medicine (J.-A.S.); Department of Neurology, Cerebrovascular Center (K.-J.L., J.K., B.J.K., M.-K.H., J.Y.K., M.S.J., M.H.Y., H.-J.B.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Biostatistics (J.L.), Korea University, Seoul; and Davee Department of Neurology (P.B.G.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jun Yup Kim
- From the Seoul National University College of Medicine (J.-A.S.); Department of Neurology, Cerebrovascular Center (K.-J.L., J.K., B.J.K., M.-K.H., J.Y.K., M.S.J., M.H.Y., H.-J.B.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Biostatistics (J.L.), Korea University, Seoul; and Davee Department of Neurology (P.B.G.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Myung Suk Jang
- From the Seoul National University College of Medicine (J.-A.S.); Department of Neurology, Cerebrovascular Center (K.-J.L., J.K., B.J.K., M.-K.H., J.Y.K., M.S.J., M.H.Y., H.-J.B.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Biostatistics (J.L.), Korea University, Seoul; and Davee Department of Neurology (P.B.G.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mi Hwa Yang
- From the Seoul National University College of Medicine (J.-A.S.); Department of Neurology, Cerebrovascular Center (K.-J.L., J.K., B.J.K., M.-K.H., J.Y.K., M.S.J., M.H.Y., H.-J.B.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Biostatistics (J.L.), Korea University, Seoul; and Davee Department of Neurology (P.B.G.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Juneyoung Lee
- From the Seoul National University College of Medicine (J.-A.S.); Department of Neurology, Cerebrovascular Center (K.-J.L., J.K., B.J.K., M.-K.H., J.Y.K., M.S.J., M.H.Y., H.-J.B.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Biostatistics (J.L.), Korea University, Seoul; and Davee Department of Neurology (P.B.G.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Philip B Gorelick
- From the Seoul National University College of Medicine (J.-A.S.); Department of Neurology, Cerebrovascular Center (K.-J.L., J.K., B.J.K., M.-K.H., J.Y.K., M.S.J., M.H.Y., H.-J.B.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Biostatistics (J.L.), Korea University, Seoul; and Davee Department of Neurology (P.B.G.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Hee-Joon Bae
- From the Seoul National University College of Medicine (J.-A.S.); Department of Neurology, Cerebrovascular Center (K.-J.L., J.K., B.J.K., M.-K.H., J.Y.K., M.S.J., M.H.Y., H.-J.B.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam; Clinical Research Center (J.S.L.), Asan Medical Center, Seoul; Department of Biostatistics (J.L.), Korea University, Seoul; and Davee Department of Neurology (P.B.G.), Northwestern University Feinberg School of Medicine, Chicago, IL.
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Joo YS, Lee C, Kim HW, Jhee J, Yun HR, Park JT, Chang TI, Yoo TH, Kang SW, Han SH. Association of Longitudinal Trajectories of Systolic BP with Risk of Incident CKD: Results from the Korean Genome and Epidemiology Study. J Am Soc Nephrol 2020; 31:2133-2144. [PMID: 32759227 DOI: 10.1681/asn.2020010084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 06/11/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Although hypertension is a well known risk factor for CKD, few studies have evaluated the association between temporal trends of systolic BP and kidney function decline in persons without hypertension. METHODS We studied whether changes in systolic BP over time could influence incident CKD development in 4643 individuals without CKD and hypertension participating in the Korean Genome and Epidemiology Study, a prospective community-based cohort study. Using group-based trajectory modeling, we categorized three distinct systolic BP trajectories: decreasing, stable, and increasing. The primary outcome was incident CKD development, defined as two consecutive eGFR measurements <60 ml/min per 1.73 m2. RESULTS Among participants with an increasing systolic BP trajectory, systolic BP increased from 105 to 124 mm Hg. During 31,936 person-years of follow-up (median 7.7 years), 339 participants developed incident CKD. CKD incidence rates were 8.9, 9.6, and 17.8 cases per 1000 person-years in participants with decreasing, stable, and increasing systolic BP trajectories, respectively. In multivariable cause-specific Cox analysis, after adjustment of baseline eGFR, systolic BP, and other confounders, increasing systolic BP trajectory associated with a 1.57-fold higher risk of incident CKD (95% confidence interval, 1.20 to 2.06) compared with a stable trajectory. There was a significant effect modification of baseline systolic BP on the association between systolic BP trajectories and CKD risk (P value for interaction =0.02), and this association was particularly evident in participants with baseline systolic BP <120 mm Hg. In addition, increasing systolic BP trajectory versus a stable trajectory was associated with higher risk of new development of albuminuria. CONCLUSIONS Increasing systolic BP over time without reaching the hypertension threshold is associated with a significantly increased risk of incident CKD in healthy adults.
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Affiliation(s)
- Young Su Joo
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea.,Division of Nephrology, Department of Internal Medicine, Myongji Hospital, Goyang, Gyeonggi-do, Republic of Korea
| | - Changhyun Lee
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea.,Division of Integrated Medicine, Department of Internal Medicine, National Health Insurance Service Medical Center, Ilsan Hospital, Goyang, Gyeonggi-do, Republic of Korea
| | - Hyung Woo Kim
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - Jonghyun Jhee
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea.,Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hae-Ryong Yun
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - Jung Tak Park
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - Tae Ik Chang
- Department of Internal Medicine, National Health Insurance Service Medical Center, Ilsan Hospital, Goyang, Gyeonggi-do, Republic of Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea.,Department of Internal Medicine, College of Medicine, Severance Biomedical Science Institute, Brain Korea 21 PLUS, Yonsei University, Seoul, Republic of Korea
| | - Seung Hyeok Han
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
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24
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Silverman A, Kodali S, Sheth KN, Petersen NH. Hemodynamics and Hemorrhagic Transformation After Endovascular Therapy for Ischemic Stroke. Front Neurol 2020; 11:728. [PMID: 32765416 PMCID: PMC7379334 DOI: 10.3389/fneur.2020.00728] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 06/15/2020] [Indexed: 12/19/2022] Open
Abstract
Hemorrhagic transformation remains a potentially catastrophic complication of reperfusion therapies for the treatment of large-vessel occlusion ischemic stroke. Observational studies have found an increased risk of hemorrhagic transformation in patients with elevated blood pressure as well as a high degree of blood pressure variability, suggesting a link between hemodynamics and hemorrhagic transformation. Current society-endorsed guidelines recommend maintaining blood pressure below a fixed threshold of 180/105 mmHg regardless of thrombolytic or endovascular intervention. However, given the high recanalization rates with mechanical thrombectomy, it is unclear if the same hemodynamic goals from the pre-thrombectomy era apply. Also, individual patient factors such as the degree of reperfusion, infarct size, and collateral status likely need to be considered. In this review, we will discuss current evidence linking hemodynamics to hemorrhagic transformation after mechanical thrombectomy. In addition, we will review the clinical relevance of cerebral autoregulation in stroke, highlighting recent studies that have harnessed autoregulatory physiology to define and trend individualized limits of autoregulation. This review will go on to emphasize the translatability of this approach to stroke management. Finally, we will discuss novel statistical approaches like trajectory analysis to post-thrombectomy hemodynamics.
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Affiliation(s)
- Andrew Silverman
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
| | - Sreeja Kodali
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
| | - Kevin N Sheth
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
| | - Nils H Petersen
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
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Atrial Fibrillation-Associated Ischemic Stroke Patients With Prior Anticoagulation Have Higher Risk for Recurrent Stroke. Stroke 2020; 51:1150-1157. [DOI: 10.1161/strokeaha.119.027275] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Ischemic stroke associated with nonvalvular atrial fibrillation (NVAF) despite prior anticoagulation may indicate underlying problems that nullify the stroke-preventing effects of oral anticoagulants. We aimed to evaluate the risk for recurrent stroke in patients with NVAF with prior anticoagulation, compared with that in patients without prior anticoagulation.
Methods—
This study comprised pooled individual patient data on NVAF-associated acute ischemic stroke or transient ischemic attack from 2011 to 2014 arising from the Clinical Research Collaboration for Stroke in Korea (15 South Korean stroke centers) and the Stroke Acute Management With Urgent Risk-Factor Assessment and Improvement-NVAF registry (18 Japanese stroke centers). Data on 4841 eligible patients from the Clinical Research Collaboration for Stroke in Korea registry were pooled with data on all patients (n=1192) in the Stroke Acute Management with Urgent Risk-factor Assessment and Improvement-NVAF registry. The primary outcome was recurrent ischemic stroke. The secondary outcomes were hemorrhagic stroke and all-cause death. Outcome events were captured up to 1 year after the index event.
Results—
Among the 6033 patients in the full cohort, 5645 patients were analyzed, of whom 1129 patients (20.0%) had received prior anticoagulation. Median age was 75 years (interquartile range, 69–81 years), and 2649 patients (46.9%) were women. Follow-up data of 4617 patient-years (median follow-up 365 days, interquartile range 335–365 days) were available. The cumulative incidence of recurrent ischemic stroke in patients with prior anticoagulation was 5.3% (60/1129), compared with the 2.9% (130/4516) incidence in patients without prior anticoagulation. The risk for recurrent ischemic stroke was higher in patients with prior anticoagulation than in those without (multivariable Cox shared-frailty model, hazard ratio 1.50 [95% CI, 1.02–2.21]). No significant differences in the risks for hemorrhagic stroke and mortality were seen between the 2 groups.
Conclusions—
The risk for recurrent ischemic stroke may be higher in NVAF-associated stroke patients with prior anticoagulation than in those without prior anticoagulation.
Registration—
URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT01581502.
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Kim SH, Kim JI, Lee JY, Park CI, Hong JY, Lee SS. Is spontaneous normalization of systolic blood pressure within 24 hours after ischemic stroke onset related with favorable outcomes? PLoS One 2019; 14:e0224293. [PMID: 31639163 PMCID: PMC6804986 DOI: 10.1371/journal.pone.0224293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 10/09/2019] [Indexed: 11/18/2022] Open
Abstract
Background In acute ischemic stroke, blood pressure (BP) tends to rise initially and fall to a baseline level within 24–48 hours. Previous studies reported several different effects of BPs during acute ischemic stroke on clinical outcomes, which was partly due to the different time intervals from stroke onset to BP measurement. Methods All patients with acute ischemic stroke (onset ≤3 hours) who lived independently before the stroke, were consecutively enrolled for a 62-month period. BPs at 0, 12, and 24 hours after admission were collected. A favorable outcome was defined as a modified Rankin Scale (mRS) score 0–2 at discharge. For different standards of BP management, patients were grouped and analyzed according to intravenous (IV) tissue plasminogen activator (tPA) treatment and favorable outcome. Results Among the 446 enrolled patients, 227 patients underwent IV tPA treatment and 216 had mRS score 0–2 at discharge. Patients with favorable outcomes had lower initial NIH Stroke Scale (NIHSS) scores, less frequent progressive neurological deficits, and lower systolic BP (SBP) 12 and 24 hours after admission than patients with unfavorable outcomes, regardless of whether they underwent tPA treatment or not (p <0.05). The BP decreased over a period of 24 hours after admission. In logistic regression analysis, the independent variables associated with favorable outcome were the initial NIHSS score, a progressive neurological deficit, a previous stroke, and the SBP 24 hours after admission in the patients who underwent tPA treatment and the initial NIHSS score and a progressive neurological deficit in the patients who did not undergo tPA treatment (p <0.05). Conclusions The SBPs at 12 and 24 hours after admission were lower in acute stroke patients with favorable outcomes than in the other patients, regardless of whether the patients underwent tPA therapy and the SBP at 24 hours was an independent predictor of favorable outcomes among the patients who underwent tPA treatment.
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Affiliation(s)
- Seo Hyun Kim
- Department of Neurology, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do, Republic of Korea
- * E-mail:
| | - Ji In Kim
- Department of Neurology, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do, Republic of Korea
| | - Ji-Yong Lee
- Department of Neurology, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do, Republic of Korea
| | - Chan Ik Park
- Department of Neurology, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do, Republic of Korea
| | - Jin Yong Hong
- Department of Neurology, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do, Republic of Korea
| | - Sung-Soo Lee
- Department of Neurology, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do, Republic of Korea
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27
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Gorelick PB, Qureshi S, Farooq MU. Management of blood pressure in stroke. INTERNATIONAL JOURNAL CARDIOLOGY HYPERTENSION 2019; 3:100021. [PMID: 33447751 PMCID: PMC7803067 DOI: 10.1016/j.ijchy.2019.100021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 10/09/2019] [Indexed: 01/01/2023]
Abstract
Objective In this review and opinion piece, we discuss recent United States (US)-based guidance statements on the management of BP in stroke according to stroke type and stage of stroke. Methods We reviewed the most recent guidance statements on BP control from United States (US)-based organizations such as the American Heart Association/American Stroke Association (AHA/ASA) and American College of Cardiology (ACC), and articles available to the authors in their personal files. Results The key BP target before starting alteplase (t-PA) is < 185/110 mm Hg, and the maintenance BP after tPA administration is < 180/105 mm Hg. For IPH patients with systolic BP between 150 and 220 mm Hg and no contraindication to acute BP reduction therapy, acute lowering to 140 mm Hg systolic BP is safe. For persons with small vessel or lacunar cerebral ischemia, a reasonable BP lowering target is < 130 mm Hg systolic. For primary stroke prevention, the target BP for those with hypertension is < 140/90 mm Hg and self-measured BP is recommended to assist in BP control. Recent study and guidance suggest a BP target of <130/80 mm Hg for both primary and recurrent stroke prevention. BP control is reasonable for the prevention of cognitive decline or dementia. Conclusions BP targets for the proper management of stroke vary by chronological stage of stroke and by stroke subtype. Furthermore, consideration should be given to control of BP variability, especially in the acute phases of stroke, as it may play a role in conferring longer term outcomes. Stroke is an important cause of morbidity and mortality worldwide, and is well suited for prevention and acute treatment with proper BP management. BP targets in acute ischemic stroke vary whether intravenous alteplase is administered or an endovascular intervention is implemented or not. In acute intraparenchymal hemorrhage of the brain (IPH), it is reasonable to lower BP to a systolic level of 140–150 or up to 160 mm Hg. For both first and recurrent stroke prevention it is reasonable to aim for a BP target of <130/80 mm Hg based on the recent data. The revised BP target has been lowered to <130/80 mm Hg for prevention of major cardiovascular outcomes including stroke. Intensive BP control potentially preserves cognition, brain health, and brain structural integrity. Blood pressure variability is a new target for study in the acute treatment and prevention of stroke.
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Affiliation(s)
- Philip B Gorelick
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Translational Neuroscience, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Shakaib Qureshi
- Hauenstein Neurosciences, 220 Cherry Street SE, Grand Rapids, MI 49503, USA
| | - Muhammad U Farooq
- Hauenstein Neurosciences, 220 Cherry Street SE, Grand Rapids, MI 49503, USA
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Xu J, Dai L, Chen Z, Wang A, Mo J, Cheng A, Meng X, Wang Y, Zhao X, Wang Y. Acute‐phase blood pressure trajectories and clinical outcomes in ischemic stroke. J Clin Hypertens (Greenwich) 2019; 21:1108-1114. [PMID: 31256446 DOI: 10.1111/jch.13599] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/25/2019] [Accepted: 05/28/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Jie Xu
- Department of Neurology, Beijing Tiantan Hospital Capital Medical University Beijing China
- China National Clinical Research Center for Neurological Diseases Beijing China
- Center of Stroke Beijing Institute for Brain Disorders Beijing China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease Beijing China
| | - Liye Dai
- Department of Neurology, Beijing Tiantan Hospital Capital Medical University Beijing China
- China National Clinical Research Center for Neurological Diseases Beijing China
- Center of Stroke Beijing Institute for Brain Disorders Beijing China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease Beijing China
| | - Zimo Chen
- Department of Neurology, Beijing Tiantan Hospital Capital Medical University Beijing China
- China National Clinical Research Center for Neurological Diseases Beijing China
- Center of Stroke Beijing Institute for Brain Disorders Beijing China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease Beijing China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital Capital Medical University Beijing China
- China National Clinical Research Center for Neurological Diseases Beijing China
- Center of Stroke Beijing Institute for Brain Disorders Beijing China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease Beijing China
| | - Jinglin Mo
- Department of Neurology, Beijing Tiantan Hospital Capital Medical University Beijing China
- China National Clinical Research Center for Neurological Diseases Beijing China
- Center of Stroke Beijing Institute for Brain Disorders Beijing China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease Beijing China
| | - Aichun Cheng
- Department of Neurology, Beijing Tiantan Hospital Capital Medical University Beijing China
- China National Clinical Research Center for Neurological Diseases Beijing China
- Center of Stroke Beijing Institute for Brain Disorders Beijing China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease Beijing China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital Capital Medical University Beijing China
- China National Clinical Research Center for Neurological Diseases Beijing China
- Center of Stroke Beijing Institute for Brain Disorders Beijing China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease Beijing China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital Capital Medical University Beijing China
- China National Clinical Research Center for Neurological Diseases Beijing China
- Center of Stroke Beijing Institute for Brain Disorders Beijing China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease Beijing China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital Capital Medical University Beijing China
- China National Clinical Research Center for Neurological Diseases Beijing China
- Center of Stroke Beijing Institute for Brain Disorders Beijing China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease Beijing China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital Capital Medical University Beijing China
- China National Clinical Research Center for Neurological Diseases Beijing China
- Center of Stroke Beijing Institute for Brain Disorders Beijing China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease Beijing China
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29
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Jee Y, Jeon J, Back JH, Ryu M, Cho SI. Trajectory of Smoking and Incidence of Atherosclerotic Cardiovascular Disease among Korean Young Adult Men. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16122219. [PMID: 31238495 PMCID: PMC6617148 DOI: 10.3390/ijerph16122219] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 06/13/2019] [Accepted: 06/18/2019] [Indexed: 11/16/2022]
Abstract
Introduction: Smoking among young adults is associated with atherosclerotic cardiovascular disease (ASCVD) in middle age. Our aim was to analyze the trajectory of smoking in young adults and analyze the effects of the trajectory group on incident ASCVD. Methods: This study was conducted among 60,709 young adult men aged 20–29 years who received health screening every two years from 1992–2004. Trajectory analysis was performed through smoking survey data measured 7 times during this period. ASCVD, including ischemic heart disease (IHD) and stroke events were confirmed from 2005–2015. The association between the trajectory group and ASCVD risk was analyzed using Cox proportional hazard models, controlling for covariates and mediators. Results: Trajectory analysis showed that smoking categorized into five groups as follows: Group 1 (28.3%), low steady; Group 2 (14.7%), lowering; Group 3 (17.3%), high steady; Group 4 (15.6%), rise and fall; and Group 5 (24.2%), very high steady. The model performance of the trajectory model (Akaike information criterion; AIC = 51,670.78) with mediators was better than the model (AIC = 51,847.85) without mediators. Group 5 showed a 49% higher risk of ASCVD than Group 1. The risk of IHD was 1.63-times higher for Group 5 and 1.31-times higher for Group 4, compared to Group 1. Compared to Group 1, Group 5 had a 1.36- and 1.58-times higher risk for total stroke and ischemic stroke, respectively. Conclusions: In young adult men, the multiple measured trajectory model with mediators was far more informative than one-time smoking for explaining the association with cardiovascular disease.
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Affiliation(s)
- Yongho Jee
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Korea.
- Institute for Health Promotion, Graduate School of Public Health, Yonsei University, 50-1 Yonsei-ro Seodaemun-gu, Seoul 03722, Korea.
| | - Jooeun Jeon
- Institute for Health Promotion, Graduate School of Public Health, Yonsei University, 50-1 Yonsei-ro Seodaemun-gu, Seoul 03722, Korea.
- Department of Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, 50-1 Yonsei-ro Seodaemun-gu, Seoul 03722, Korea.
| | - Joung Hwan Back
- Health Insurance Policy Research Institute, National Health Insurance Service, 32, Geongang-ro, Wonju-si, Gangwon-do 26464, Korea.
| | - Mikyung Ryu
- Central College, Kyonggi University, 154-42, Gwanggyosan-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do 16627, Korea.
| | - Sung-Il Cho
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Korea.
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