| Response of Blood Pressure and Blood Glucose to Treatment With Recombinant Tissue-Type Plasminogen Activator in Acute Ischemic Stroke: Evidence From the Virtual International Stroke Trials Archive. | |
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MedLine Citation:
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PMID: 22075999 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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BACKGROUND AND PURPOSE: Elevations in blood pressure (BP) and blood glucose are common during stroke and may represent a stress response secondary to the acute neurological deficit. If so, they should settle more completely in recombinant tissue-type plasminogen activator (rtPA)-treated patients in association with improved neurological status. METHODS: We performed a controlled comparison of 24-hour declines in BP and glucose in rtPA-treated and control patients from the Virtual Stroke International Stroke Trial Archive (VISTA) database. Twenty-four-hour falls in BP and glucose were compared using multiple regression to account for baseline imbalances. The logarithmic transformation of glucose was used and 24-hour differences expressed as ratios of 24 hours to admission geometric means. Two-way analysis of variance was used to test for interaction between rtPA and early improvement for 24-hour falls in BP and blood glucose. RESULTS: BP analysis included 5406 patients (rtPA=41%) and glucose analysis 4288 (rtPA=37%). rtPA-treated patients were younger, less likely to have a history of hypertension or diabetes, and had more severe strokes on admission. BP and glucose were lower at baseline in rtPA-treated patients than control subjects. On regression, rtPA predicted significantly greater 24-hour falls in systolic BP (β=3.9; 95% CI, 2.8-5.0), diastolic BP (β=3.1; 95% CI, 2.4-3.9), and glucose (β=0.97; 95% CI, 0.95-0.99). rtPA did not interact with early neurological improvement for 24-hour falls in systolic BP (P=0.72), diastolic BP (P=0.79), or blood glucose (P=0.51). CONCLUSIONS: A stress response does not appear to be the principal cause of elevations in BP and glucose during stroke. |
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Authors:
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Daniel M Kerr; Rachael L Fulton; Peter Higgins; Philip M W Bath; Ashfaq Shuaib; Patrick Lyden; Kennedy R Lees; |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-11-10 |
Journal Detail:
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Title: Stroke; a journal of cerebral circulation Volume: - ISSN: 1524-4628 ISO Abbreviation: - Publication Date: 2011 Nov |
Date Detail:
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Created Date: 2011-11-14 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0235266 Medline TA: Stroke Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Western Infirmary, Glasgow, UK; the Stroke Trials Unit, Division of Stroke, University of Nottingham, Nottingham, UK; the Stroke Research Program, University of Alberta, Edmonton, Alberta, Canada; and the Department of Neurology, University of California-San Diego, San Diego, CA. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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