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Intensive Blood Pressure-Lowering Treatment in Patients with Acute Lacunar Infarction.
MedLine Citation:
PMID:  23111011     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: The optimal management of high blood pressure (BP) during the acute stage of stroke has yet to be established. To test the extent to which BP can be lowered without causing adverse effects and to determine the safety or efficacy of administration of antihypertensive agents in acute ischemic stroke, we performed ambulatory BP monitoring (ABPM) before and after administration of angiotensin receptor blockers (ARBs) with and without diuretics to monitor the ABPM profile after acute lacunar infarction. Patients with lacunar infarcts are presumed to be less vulnerable to reduced cerebral perfusion pressure in the ischemic tissue because of BP lowering. METHODS: We prospectively performed ABPM during the acute stage and around 3 weeks after ictus for 59 patients with lacunar infarction. As a historical control group, we selected 60 consecutive patients with acute lacunar infarction who were admitted during the period of 1 year before the present study and treated according to the guidelines. RESULTS: Baseline data, prevalence of progressive motor deficits, and modified Rankin Scale scores 3 months after ictus were not significantly different between both groups. ARB with or without diuretics lowered 24-hour systolic BP and diastolic BP by 27.8 and 12.7 mm Hg, daytime systolic BP and diastolic BP by 26.8 and 12.0 mm Hg, and nighttime systolic BP and diastolic BP by 30.2 and 12.0 mm Hg. The incidence of dippers tended to increase in the second measurement from 11 (18.6%) to 20 (33.8%; P = .093). CONCLUSIONS: Considerable reduction in 24-hour BP levels was attained around day 21. The limit of BP level to which BP can be safely lowered appears to be lower than that was previously considered.
Authors:
Yasumasa Yamamoto; Yoshinari Nagakane; Tomoyuki Ohara; Eijiro Tanaka; Fukiko Morii; Takashi Koizumi; Manabu Muranishi; Hidesato Takezawa
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-10-27
Journal Detail:
Title:  Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association     Volume:  -     ISSN:  1532-8511     ISO Abbreviation:  J Stroke Cerebrovasc Dis     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-31     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9111633     Medline TA:  J Stroke Cerebrovasc Dis     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 National Stroke Association. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Neurology, Kyoto Second Red Cross Hospital, Kyoto, Japan. Electronic address: yyamamot@fg7.so-net.ne.jp.
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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