Stroke and severe preeclampsia and eclampsia: a paradigm shift focusing on systolic blood pressure.
OBJECTIVE
To identify important clinical correlates of stroke in patients with preeclampsia and eclampsia.


METHODS
The case histories of 28 patients who sustained a stroke in association with severe preeclampsia and eclampsia were scrutinized with particular attention to blood pressures.


RESULTS
Stroke occurred antepartum in 12 patients, postpartum in 16. Stroke was classified as hemorrhagic-arterial in 25 of 27 patients (92.6%) and thrombotic-arterial in 2 others. Multiple sites were involved in 37% without distinct pattern. In the 24 patients being treated immediately before stroke, systolic pressure was 160 mm Hg or greater in 23 (95.8%) and more than 155 mm Hg in 100%. In contrast, only 3 of 24 patients (12.5%) exhibited prestroke diastolic pressures of 110 mm Hg or greater, only 5 of 28 reached 105 mm Hg, and only 6 (25%) exceeded a mean arterial pressure of 130 mm Hg before stroke. Only 3 patients received prestroke antihypertensives. Twelve patients sustained a stroke while receiving magnesium sulfate infusion; 8 had eclampsia. Although all blood pressure means after stroke were significantly higher than prestroke, only 5 patients exhibited more than 110 mm Hg diastolic pressures. In 18 of 28 patients, hemolysis, elevated liver enzymes, low platelets syndrome did not significantly alter blood pressures compared with non-hemolysis, elevated liver enzymes, low platelets. Mean systolic and diastolic changes from pregnancy baseline to prestroke values were 64.4 and 30.6 mm Hg, respectively. Maternal mortality was 53.6%; only 3 patients escaped permanent significant morbidity.


CONCLUSIONS
In contrast to severe systolic hypertension, severe diastolic hypertension does not develop before stroke in most patients with severe preeclampsia and eclampsia. A paradigm shift is needed toward considering antihypertensive therapy for severely preeclamptic and eclamptic patients when systolic blood pressure reaches or exceeds 155-160 mm Hg.


METHODS
III.
Martin
James N
JN
Department of Obstetrics and Gynecology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216-4505, USA. jnmartin@obgyn.umsmed.edu
Thigpen
Brad D
BD
Moore
Robert C
RC
Rose
Carl H
CH
Cushman
Julie
J
May
Warren
W
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D001795:Blood Pressure Determination; D015897:Comorbidity; D004461:Eclampsia / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D017359:HELLP Syndrome / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology*; D015994:Incidence; D011225:Pre-Eclampsia / Q000175:diagnosis / Q000453:epidemiology*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011296:Prenatal Diagnosis; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology*; D013599:Systole / Q000502:physiology