title: Induced-hypertension in progressing lacunar infarction.
abstract: BACKGROUND
  Although an early neurological deterioration after lacunar infarction is not rare, its therapeutic options are still undetermined. We investigated the effect of induced-hypertension in lacunar infarction with motor progression.
  
  
  METHODS
  We reviewed 82 lacunar infarction patients who experienced motor progression [≥ 1-point increase of NIH stroke scale (NIHSS) during hospitalization]. Induced-hypertension using phenylephrine was applied to 52 patients and the others received conventional treatment. Target blood pressure (BP) was defined as a 20% increase of initial systolic BP and motor stabilization time as a period from motor progression to motor stabilization. Good outcome was designated as a modified Rankin disability scale 0-2 at discharge in phenylephrine group.
  
  
  RESULTS
  Phenylephrine group (vs. conventional group) had a lower NIHSS motor score after each treatment (p=0.022), a shorter motor stabilization time (p<0.001) and hospitalization period (p=0.047), although there were not significantly different from baseline clinical and laboratory findings (ie. age, sex, risk factors for stroke, initial BPs, and NIHSS motor score) in two groups. In multiple regression analysis, a history of hypertension (odds ratio, OR 7.11, 95% CI 1.43-35.31, p=0.016), achievement of target BP (OR 8.13, 95% CI 1.49-44.45, p=0.016) and motor stabilization time (OR 0.51 per 1-day increase, 95% CI 0.29-0.87, p=0.015) were independent predictors for good outcome in the phenyephrine group. Side effects of phenylephrine treatment were transient chest tightness (n=3) and dysuria (n=2).
  
  
  CONCLUSIONS
  The present study suggests that phenylephrine induced-hypertension can result in early motor restoration without serious side effects in progressing lacunar infarction.
authors.affiliation: Department of Neurology, Ajou University School of Medicine, Suwon, Republic of Korea.
authors.forename: Tae Sung
authors.initials: TS
authors.lastname: Lim
authors.forename: Ji Man
authors.initials: JM
authors.lastname: Hong
authors.forename: Jin Soo
authors.initials: JS
authors.lastname: Lee
authors.forename: Dong Hoon
authors.initials: DH
authors.lastname: Shin
authors.forename: Jun Young
authors.initials: JY
authors.lastname: Choi
authors.forename: Kyoon
authors.initials: K
authors.lastname: Huh
mesh_terms: D000368:Aged; D002316:Cardiotonic Agents / Q000009:adverse effects / Q000627:therapeutic use; D002548:Cerebral Revascularization / Q000379:methods*; D018450:Disease Progression; D005260:Female; D006801:Humans; D006973:Hypertension / Q000139:chemically induced* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010656:Phenylephrine / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D059409:Stroke, Lacunar / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D002316:Cardiotonic Agents; D010656:Phenylephrine