Blood pressure management in stroke patients

Heart Rate Variability for Outcome Prediction in Intracerebral and Subarachnoid Hemorrhage: A Systematic Review

This systematic review presents clinical evidence on the association of heart rate variability with outcome prediction in intracerebral and subarachnoid hemorrhages. The literature search led to the retrieval of 19 significant studies. Outcome prediction included functional outcome, cardiovascular complications, secondary brain injury, and mortality. Various aspects of heart rate recording and analysis, based on linear time and frequency domains and a non-linear entropy approach, are reviewed. Heart rate variability was consistently associated with poor functional outcome and mortality, while controversial results were found regarding the association between heart rate variability and secondary brain injury and cardiovascular complications.

The effect of the multimodal intervention on blood pressure in patients with first ischemic stroke: A randomized controlled trial

Background

Multimodal intervention is currently promoted to control blood pressure in patients with first ischemic stroke. However, a dearth of studies has examined the influence of the intervention among patients with ischemic stroke, particularly in Thailand.

Objective

This study aimed to determine the effect of the multimodal intervention on blood pressure in patients with first ischemic stroke.

Methods

A randomized controlled trial was conducted. Sixty participants were randomly selected from two tertiary hospitals in Thailand. Eligible participants were randomly assigned into an experimental group (n = 30) and a control group (n = 30). The experimental group was provided with the multimodal intervention, while the control group was given the usual care. Data were collected from May 2021 to October 2021 at baseline (pre-test), 4^th week, 8^th week, and 12^th week using the demographic data form and sphygmomanometer. The data were analyzed using the Chi-square test, t-test, and repeated measure analysis of variance (ANOVA).

Results

The participants' blood pressures after receiving the multimodal intervention were lower than those before receiving the multimodal intervention. Both systolic and diastolic blood pressure were statistically significantly decreased over time, starting from baseline to the 8^th week and 12^th week (p <0.001). In addition, the participants' mean scores of systolic blood pressure (F (1, 58) = 4.059, p = 0.049) and diastolic blood pressure (F (1, 58) = 4.515, p = 0.038) were lower than the control group.

Conclusion

The multimodal intervention is effective in controlling blood pressure. Therefore, nurses should educate patients with ischemic stroke to manage systolic and diastolic blood pressure, facilitate the patient's participation in the exercise program, and monitor the patients via telephone to continue blood pressure control.

Trial Registry

Thai Clinical Trials Registry (TCTR) identifier number 20210318001.

Internal Carotid Artery Occlusion: Management

PURPOSE OF REVIEW

Acute internal carotid artery occlusion (ICAO) is associated with high rates of morbidity and mortality, whereas chronic ICAO can present insidiously with recurrent strokes. In this review, we discuss the medical and surgical management approaches among patients with acute, subacute, and chronic ICAO.

RECENT FINDINGS

We reviewed the recent literature regarding clinical presentation of acute and chronic cases of ICAO, and discuss the current data, accepted guidelines, and prospects. Surgical, endovascular, or a combination (hybrid) revascularization has been shown to be effective in recanalization with improved functional outcomes in patients with ICAO in comparison to systemic thrombolysis or medical therapy alone. Future prospective or randomized clinical trials are warranted to elucidate the procedural superiority for revascularization of patients with ICAO.

Hemorrhagic Transformation After Ischemic Stroke: Mechanisms and Management

Symptomatic hemorrhagic transformation (HT) is one of the complications most likely to lead to death in patients with acute ischemic stroke. HT after acute ischemic stroke is diagnosed when certain areas of cerebral infarction appear as cerebral hemorrhage on radiological images. Its mechanisms are usually explained by disruption of the blood-brain barrier and reperfusion injury that causes leakage of peripheral blood cells. In ischemic infarction, HT may be a natural progression of acute ischemic stroke and can be facilitated or enhanced by reperfusion therapy. Therefore, to balance risks and benefits, HT occurrence in acute stroke settings is an important factor to be considered by physicians to determine whether recanalization therapy should be performed. This review aims to illustrate the pathophysiological mechanisms of HT, outline most HT-related factors after reperfusion therapy, and describe prevention strategies for the occurrence and enlargement of HT, such as blood pressure control. Finally, we propose a promising therapeutic approach based on biological research studies that would help clinicians treat such catastrophic complications.