Blood Pressure Goals in Acute Stroke

Figures

• 

  Figure 1.. Flow diagram of selection procedure for studies.

• 

  Figure 2.. Association of hyperacute (D1, upper part) and acute (D2–7, lower part) standard deviation of systolic blood pressure (SBP) by fifths and primary outcome of death or dependency at 90 days. Standard deviation (SD) was estimated using 5 measurements at 1, 6, 12, 18, and 24 hours in the hyperacute phase on Day 1, and 12 measurements from Day 2 to 7 (morning and evening each day) in the acute phase on Day 2–7, respectively. Model 1 was adjusted for age, sex, and randomized group (left panels). Model 2 was adjusted for variables in model 1 plus region, hematoma volume at baseline, high scores on the National Institutes of Health Stroke Scale (middle panels). Model 3 was adjusted for all variables in model 2 and mean SBP in each phase (right panels). The range of SD for each group was < 8.1, 8.1 to 11.4, 11.5 to 15.0, 15.1 to 19.9, ≥20.0, respectively, for hyperacute phase, <8.8, 8.8 to 11.3, 11.4 to 13.7, 13.8 to 17.0, ≥17.1, respectively, for acute phase. Reproduced with permission from reference 72.

• 

  Figure 3.. Effects of achieved systolic blood pressure (SBP, A: 1–24 hours, B: 2–7 days) on score of the modified Rankin Scale at 90 days. Odds ratios and 95% confidence intervals (CI, shaded areas) were estimated using ordinal analyses and were shown according to achieved SBP after adjustment for age, sex, region, time from onset to randomization, the National Institutes of Health Stroke Scale score, volume and location of hematoma, intraventricular extension, and randomized treatment. The reference was achieved systolic blood pressure of 130 mm Hg. Reproduced with permission from reference 73.

• 

  Figure 4.. Associations of categorical systolic blood pressure (SBP) summary measures and outcomes. Odds ratio (OR) and 95% confidence interval (CI) are comparisons between each category and the reference, adjusted for age (<65 vs. ≥65), sex, ethnicity (Asian vs. non-Asian), degree of neurological impairment (the National Institutes of Health Stroke Scale score < 8 vs. ≥8), pre-morbid function (modified Rankin scale scores 0 vs. 1), pre-morbid use of antithrombotic agents (aspirin, other antiplatelet agent, or warfarin] and antihypertensive agents, and history of hypertension, stroke, coronary artery disease, diabetes mellitus, and atrial fibrillation, and randomized treatment (intensive blood pressure control, guideline-recommended blood pressure control, low-dose alteplase, and standard-dose alteplase). Patients: 4511 acute ischemic stroke <4.5 hrs; CT/MRI confirmed, alteplase-eligible according to guidelines. Intervention: intensive (target SBP 130–140 mm Hg <1 hr, for 72 hrs), local agents, vs. guideline-recommended BP lowering (SBP < 180 mm Hg). Attaining early and consistent reductions in SBP to levels <140 mm Hg, even as low as 110–120 mm Hg, over 24 hours is associated with better…