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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."


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Title Annotation:Neurology
Author:Kirn, Timothy F.
Publication:Internal Medicine News
Geographic Code:1USA
Date:Dec 1, 2005
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