A pilot randomized trial of induced blood pressure elevation: effects on function and focal perfusion in acute and subacute stroke.
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 noninfarcted 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 hypoperfused 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.


CONCLUSIONS
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.
Hillis
A E
AE
Department of Neurology, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Md., USA. argye@jhmi.edu
Ulatowski
J A
JA
Barker
P B
PB
Torbey
M
M
Ziai
W
W
Beauchamp
N J
NJ
Oh
S
S
Wityk
R J
RJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology*; D002560:Cerebrovascular Circulation / Q000187:drug effects / Q000502:physiology*; D004359:Drug Therapy, Combination; D005260:Female; D005438:Fludrocortisone / Q000008:administration & dosage / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008879:Midodrine / Q000008:administration & dosage / Q000627:therapeutic use*; D010656:Phenylephrine / Q000008:administration & dosage / Q000627:therapeutic use*; D010865:Pilot Projects; D020127:Recovery of Function / Q000187:drug effects / Q000502:physiology*; D012965:Sodium Chloride / Q000008:administration & dosage / Q000627:therapeutic use*; D020521:Stroke / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology*; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000627:therapeutic use*
D014662:Vasoconstrictor Agents; D010656:Phenylephrine; D012965:Sodium Chloride; D008879:Midodrine; D005438:Fludrocortisone