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Intern Talk
Nicholas Reynolds
Introduction
• BP increased in stroke and usually
decreases spontaneously over time
• BP higher in patients with acute str...
However
• High BP more common in individuals with
stroke than general population
• A) High post-stroke BP
• B) Blood press...
Causes for increased
post-stroke HTN
• Disturbed autoregulation
• autonomic reactivity
• neuroendocrine factors
• headache...
Troubling point
• The reduction of blood pressure after
acute stroke is of no benefit or slight harm:
ischemic stroke
• So...
Troubling point
• No clear physiological explanation for
these findings
Hypothesis
• Post-stroke hypertension due to recent
premorbid increase in blood pressure
Design
• Oxfordshire from 2002 to 2012
• Determine relation between premorbid
and acute post-event blood pressure in
two s...
Design
• post-stroke BP
• NIHSS stroke scale >3
• TOAST (Trial of Org 10172 in Acute
ischemic stroke treatment) for subtyp...
Analysis
• 1st event only
• Exclusion:TIA, minor stroke (NIH <3)
• mean 10 yr premorbid BP, highest
premorbid BP, visit-vi...
Results
• 636 eligible patient
• median premorbid BP measurement: 17 (8-
31 IRQ)
• positive correlation between number
pre...
Results
• most recent premorbid systolic BP in
ischemic stroke no greater in period before
stroke BUT systolic BP higher i...
Discussion
• premorbid systolic BP increased in patients
with intracerebral hemorrhage substantially
following stroke
• no...
Discussion
• Post-stroke BP higher than most recent
premorbid BP suggesting post-stroke
factors leading to rise - cushing’...
Discussion
• Explanation of equivocal findings of BP
reduction in ischemic stroke
• Highlight need for long-term BP contro...
Limitations
• Late presentation
• Post stroke use of antihypertensives
• Measurement error
• no systemic protocol for reco...
Intern talk - BP and stroke
Intern talk - BP and stroke
Intern talk - BP and stroke
Intern talk - BP and stroke
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Intern talk - BP and stroke

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Intern talk - BP and stroke

  1. 1. Intern Talk Nicholas Reynolds
  2. 2. Introduction • BP increased in stroke and usually decreases spontaneously over time • BP higher in patients with acute stroke than other acute illnesses
  3. 3. However • High BP more common in individuals with stroke than general population • A) High post-stroke BP • B) Blood pressure variability
  4. 4. Causes for increased post-stroke HTN • Disturbed autoregulation • autonomic reactivity • neuroendocrine factors • headache, urinary retention, etc.
  5. 5. Troubling point • The reduction of blood pressure after acute stroke is of no benefit or slight harm: ischemic stroke • Some benefit: intracerebral hemorrhage
  6. 6. Troubling point • No clear physiological explanation for these findings
  7. 7. Hypothesis • Post-stroke hypertension due to recent premorbid increase in blood pressure
  8. 8. Design • Oxfordshire from 2002 to 2012 • Determine relation between premorbid and acute post-event blood pressure in two stroke subtypes in oxford vascular study
  9. 9. Design • post-stroke BP • NIHSS stroke scale >3 • TOAST (Trial of Org 10172 in Acute ischemic stroke treatment) for subtype classification • European guidelines lowered BP only if >220 mmHg systolic or >120 mmHg diastolic
  10. 10. Analysis • 1st event only • Exclusion:TIA, minor stroke (NIH <3) • mean 10 yr premorbid BP, highest premorbid BP, visit-visit variability, coefficient of variation, variation independent mean • log(time scale) • pre-event to post-event comparision using paired t test
  11. 11. Results • 636 eligible patient • median premorbid BP measurement: 17 (8- 31 IRQ) • positive correlation between number premorbid readings and mean premorbid systolic BP • mean premorbid systolic BP > ischemic stroke (6.5 mmHg CI 0.5-12) • mean premorbid visit-visit variability SD 16-89 vs 15-13 mmHg) ischemic vs. hemorrhagic
  12. 12. Results • most recent premorbid systolic BP in ischemic stroke no greater in period before stroke BUT systolic BP higher in weeks and days before intracranial hemorrhage
  13. 13. Discussion • premorbid systolic BP increased in patients with intracerebral hemorrhage substantially following stroke • no difference for ischemic stroke
  14. 14. Discussion • Post-stroke BP higher than most recent premorbid BP suggesting post-stroke factors leading to rise - cushing’s response, stress • Odd this not seen in ischemic stroke
  15. 15. Discussion • Explanation of equivocal findings of BP reduction in ischemic stroke • Highlight need for long-term BP control especially in prevention of intracerebral hemorrhage
  16. 16. Limitations • Late presentation • Post stroke use of antihypertensives • Measurement error • no systemic protocol for recording • exclusions for TIA, minor stroke • Biphasic intracerebellar hemorrhage peak suggests a mechanism

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