A pilot randomized trial of induced blood pressure elevation: Effects on function and focal perfusion in acute and subacute stroke

Argye Hillis-Trupe, John A Ulatowski, Peter B Barker, M. Torbey, Wendy C Ziai, N. J. Beauchamp, S. Oh, R. J. Wityk

Research output: Contribution to journalArticle

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 non-infarcted 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 hypoper-fused 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.

Original languageEnglish (US)
Pages (from-to)236-246
Number of pages11
JournalCerebrovascular Diseases
Volume16
Issue number3
DOIs
StatePublished - 2003

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Perfusion
Stroke
Blood Pressure
Arterial Pressure
Clinical Trials

Keywords

  • Aphasia
  • Cerebrovascular disease/stroke
  • Hemispatial neglect

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

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title = "A pilot randomized trial of induced blood pressure elevation: Effects on function and focal perfusion in acute and subacute stroke",
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 non-infarcted 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 hypoper-fused 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.",
keywords = "Aphasia, Cerebrovascular disease/stroke, Hemispatial neglect",
author = "Argye Hillis-Trupe and Ulatowski, {John A} and Barker, {Peter B} and M. Torbey and Ziai, {Wendy C} and Beauchamp, {N. J.} and S. Oh and Wityk, {R. J.}",
year = "2003",
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TY - JOUR

T1 - A pilot randomized trial of induced blood pressure elevation

T2 - Effects on function and focal perfusion in acute and subacute stroke

AU - Hillis-Trupe, Argye

AU - Ulatowski, John A

AU - Barker, Peter B

AU - Torbey, M.

AU - Ziai, Wendy C

AU - Beauchamp, N. J.

AU - Oh, S.

AU - Wityk, R. J.

PY - 2003

Y1 - 2003

N2 - 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 non-infarcted 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 hypoper-fused 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.

AB - 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 non-infarcted 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 hypoper-fused 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.

KW - Aphasia

KW - Cerebrovascular disease/stroke

KW - Hemispatial neglect

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