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Original Paper

A Pilot Randomized Trial of Induced Blood Pressure Elevation: Effects on Function and Focal Perfusion in Acute and Subacute Stroke

Hillis A.E.a,d · Ulatowski J.A.a,b · Barker P.B.c · Torbey M.b · Ziai W.b · Beauchamp N.J.c · Oh S.e · Wityk R.J.a

Author affiliations

Departments of aNeurology, bAnesthesiology and Critical Care Medicine and cRadiology, Johns Hopkins University School of Medicine and Department of Cognitive Science, Johns Hopkins University, Baltimore, Md., and eSaint Louis University Medical School, St. Louis, Mo., USA

Related Articles for ""

Cerebrovasc Dis 2003;16:236–246

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: August 15, 2002
Accepted: December 11, 2002
Published online: July 18, 2003
Issue release date: July 2003

Number of Print Pages: 11
Number of Figures: 4
Number of Tables: 2

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: http://www.karger.com/CED

Abstract

Background: Small, unrandomized studies have indicated that pharmacologically induced blood pressure elevation may improve function in ischemic stroke, presumably by improving blood flow to ischemic, but noninfarcted tissue (which may be indicated by diffusion-perfusion mismatch on MRI). We conducted a pilot, randomized trial to evaluate effects of pharmacologically induced blood pressure elevation on function and perfusion in acute stroke. Methods: Consecutive series of patients with large diffusion-perfusion mismatch were randomly assigned to induced blood pressure elevation (‘treated’ patients, n = 9) or conventional management (‘untreated’ patients, n = 6). Results: There were no significant differences between groups at baseline. NIH Stroke Scale (NIHSS) scores were lower (better) in treated versus untreated patients at day 3 (mean 5.6 vs. 12.3; p = 0.01) and week 6–8 (mean 2.8 vs. 9.7; p < 0.04). Treated (but not untreated) patients showed significant improvement from day 1 to day 3 in NIHSS score (from mean 10.2 to 5.6; p < 0.002), cognitive score (from mean 58.7 to 27.9% errors; p < 0.002), and volume of hypoperfused tissue (mean 132 to 58 ml; p < 0.02). High Pearson correlations between the mean arterial pressure (MAP) and accuracy on daily cognitive tests indicated that functional changes were due to changes in MAP. Conclusion: Results warrant a full-scale, double-blind clinical trial to evaluate the efficacy and risk of induced blood pressure elevation in selective patients with acute/subacute stroke.

© 2003 S. Karger AG, Basel


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: August 15, 2002
Accepted: December 11, 2002
Published online: July 18, 2003
Issue release date: July 2003

Number of Print Pages: 11
Number of Figures: 4
Number of Tables: 2

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: http://www.karger.com/CED


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