Printer Friendly

Stroke death rate worsens at lower BPs.

JACKSON HOLE, WYO. -- Physicians may soon have to worry about treating blood pressure that is too low, as well as too high, in acute stroke patients, Latha G. Stead, M.D., told a meeting on high-risk emergency medicine.

Her investigations suggest that too-low blood pressure might just be worse for acute ischemic stroke patients than is high blood pressure.

Because low blood pressure could compromise cerebral blood flow to stroke-affected areas of the brain, Dr. Stead reviewed acute ischemic stroke patients seen at the Mayo Clinic over a period of 2 1/2 years.

The review showed that when mean arterial pressure was greater than 130 mm Hg. the 90-day mortality rate was about 26%. But when it was less than 90 mm Hg, the mortality rate was about 36%, said Dr. Stead of the department of emergency medicine at the Mayo Clinic, Rochester, Minn.

Further, she found specific values for diastolic and systolic blood pressure below which the mortality rate begins to increase. Mortality begins to increase when diastolic pressure drops below 70 mm Hg, systolic pressure drops below 145 mm Hg, and mean arterial pressure drops below 95 mm Hg.

The systolic cutoff of 145 mm Hg "kind of makes sense, because most patients who develop a stroke have hypertension to start," Dr. Stead said at the meeting, which was sponsored by the Mayo Clinic. "So, they are already living at a high blood pressure, and that is probably the pressure they need to perfuse their brain."

In cases of high blood pressure, the values above which mortality rates increase were a diastolic of 105 mm Hg, a systolic of 220 mm Hg, and a mean arterial pressure of 135 mm Hg, she said.

Although several clinical trials have looked at how lowering high blood pressure can improve outcome in patients with acute ischemic stroke, Dr. Stead said, no investigations had looked at how low blood pressure might influence outcomes.

Her low blood pressure findings, which might seem intuitive to emergency physicians, have been a bombshell in the neurologist community. The results already have spawned a few trials of the use of pressors or fluids in the management of ischemic stroke, she said.

"Prior to these data coming out, they weren't even looking at this concept," Dr. Stead said. "Now it's a hot topic."

BY TIMOTHY F. KIRN

Sacramento Bureau
COPYRIGHT 2005 International Medical News Group
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2005 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Title Annotation:Neurology
Author:Kirn, Timothy F.
Publication:Internal Medicine News
Geographic Code:1USA
Date:Dec 1, 2005
Words:392
Previous Article:Most carotid stent patients in registry were asymptomatic.
Next Article:Blacks are more likely to survive first stroke.
Topics:


Related Articles
Metabolic syndrome increases stroke risk. (Especially in Women).
Metabolic syndrome increases stroke risk: odds ratio higher for women.
Stroke risk rises with dietary fat and sodium: in two studies, ischemic stroke incidence was 60% higher in those consuming over 65 g of fat daily.
Combining CABG and endarterectomy.
Stroke and Alzheimer's pathology raise risk of dementia.
Brain risk from drug for stroke.
Cholesterol-lowering drugs may help cut stroke recurrence risk.
Protein 'predicts heart attack, early death, but not stroke'.
Evidence-based statewide stroke conference returns to Oklahoma City Saturday, Feb. 13, 2010.

Terms of use | Copyright © 2017 Farlex, Inc. | Feedback | For webmasters