Pharmacological elevation of blood pressure in acute stroke. Clinical effects and safety.
OBJECTIVE
Lowering of blood pressure can adversely affect ischemic symptoms in acute stroke. The aim of our study was to determine whether induced hypertension in stroke is safe and to examine its effects on neurological deficits in patients presenting with acute cerebral ischemia.


METHODS
We retrospectively reviewed all patients admitted to our neurological intensive care unit with the diagnosis of ischemic stroke over a 2.5-year period. Thirty-three patients were not given a pressor agent (Ph- group), while 30 were treated with phenylephrine (Ph+ group) in an attempt to improve cerebral perfusion.


RESULTS
Baseline characteristics showed few differences between the Ph+ and Ph- groups. Intracerebral hemorrhage, brain edema, cardiac morbidity, and mortality were not increased in the Ph+ group. In 10 of 30 Ph+ patients, a systolic blood pressure threshold was identified below which ischemic deficits worsened and above which deficits improved. The mean threshold was 156 mm Hg (range, 120 to 190 mm Hg). The mean number of stenotic/occluded cerebral arteries was greater in those Ph+ patients with an identified clinical blood pressure threshold (mean, 2.1 per patient) than in Ph+ patients without a threshold (mean, 1.2 per patient; P < .05).


CONCLUSIONS
The results suggest that careful use of phenylephrine induced hypertension is not associated with an increase in morbidity or mortality in acute stroke. Although based on a retrospective analysis of clinical practice, this report suggests that a subset of patients, particularly those with multiple stenosis of cerebral arteries, may improve neurologically upon elevation of the blood pressure.
Rordorf
G
G
Department of Neurology and Stroke Service, Massachusetts General Hospital, Boston 02114, USA. Rordorf@helix.mgh.harvard.edu
Cramer
S C
SC
Efird
J T
JT
Schwamm
L H
LH
Buonanno
F
F
Koroshetz
W J
WJ
D000208:Acute Disease; D000368:Aged; D001794:Blood Pressure / Q000187:drug effects*; D002561:Cerebrovascular Disorders / Q000188:drug therapy* / Q000503:physiopathology*; D004056:Differential Threshold; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010656:Phenylephrine / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D012449:Safety; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000009:adverse effects / Q000627:therapeutic use*
D014662:Vasoconstrictor Agents; D010656:Phenylephrine