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Effect of blood pressure on stroke severity and outcomes in acute cases

02 April 2020
Volume 12 · Issue 4



Stroke results in impairment of cerebral autoregulation. Systemic blood pressure (BP), whether low or high, may affect cerebral blood flow and cause damage to brain tissue, so is important in the context of stroke. Effective management of BP may result in less severe strokes and better outcomes for patients.


A literature search was performed to answer the research question, using the CINAHL Complete and MEDLINE Complete databases. Inclusion and exclusion criteria were applied. Full texts were reviewed for eligibility and 15 quantitative articles were selected and discussed.


Fifteen international quantitative primary research articles were selected and grouped into four themes: admission blood pressure; BP indexes/BP variability; active treatment of BP; and prehospital care. The articles were randomised controlled trials, cohort studies and one post-hoc analysis.


In patients with acute ischaemic stroke (AIS), systolic BP in the 140–160 mmHg range on admission to hospital is associated with higher rates of positive outcome and lower stroke severity. BP-lowering therapy in AIS is safe and does not affect stroke severity, but also does not alter patient outcome. In the context of intracerebral haemorrhage (ICH), intensive BP-lowering therapy to a target of 140 mmHg and maintenance of this value for 7 days produces high rates of positive long-term outcomes in terms of quality of life and Modified Rankin Scale scores. Furthermore, early initiation of BP management, namely in the prehospital environment, is beneficial. These results provide evidence that antihypertensive treatment should be provided in the prehospital environment, and support early administration of treatment to reduce systolic BP to a target of 140 mmHg, which is a beneficial value for patients experiencing ICH and AIS.

This article explores blood pressure (BP) in the context of stroke, regarding stroke severity and patient outcome. It discusses both ischaemic and haemorrhagic stroke.

Stroke is the second highest cause of mortality globally, resulting in 6.2 million deaths a year (Stroke Association, 2018). It also results in significant rates of disability; upon hospital discharge, two-thirds of stroke patients have a disability (Stroke Association, 2018). Because stroke has debilitating effects in both the short and long term, this pathological process is an important topic of discussion, and research into optimal care is vital to reduce the devastating impact on patients.

There are two key pathologies of stroke—acute ischaemic stroke (AIS) and intracerebral haemorrhage (ICH). They require different treatments, so initial management of stroke involves a rapid diagnosis of stroke pathology, via computed tomography (CT) angiography.

Patients experiencing AIS may be suitable for treatment with alteplase (Royal College of Physicians (RCP), 2016). Alteplase is a fibrinolytic agent, which produces plasmin via activation of plasminogen, resulting in thrombolysis (National Institute for Health and Care Excellence (NICE), 2018). To be eligible for treatment with thrombolysis, the patient's blood pressure (BP) must be below 185/110 mmHg. Therefore, treatment with antihypertensive therapy is recommended if the patient's BP is above this (RCP, 2016).

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