[PP.17.18] INFLUENCE OF HYPERTENSION ON STROKE OUTCOME: COMPARISON OF HEMORRHAGIC AND ISCHEMIC TYPES

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Abstract

Objective:

The management of hypertension after various types of stroke remains controversial. Recent studies indicate that the low blood pressure after stroke may reduce the risk of recurrent vascular events, but the other studies provide evidence that blood pressure should not be lowered in the first week after stroke. The aim of the study was to establish the impact of the blood pressure on the outcome of the hemorrhagic(HS) and ischemic(IS) types of stroke.

Design and method:

A total of 156 patients, (64,5 ± 7,5 y.,34F/38 M) with Ischemic(84) and Haemorragic(72) type of stroke have been investigated. The both stroke patients were classified into 2 subgroups:1st subgroup- patients with aggressive lowering of blood pressure on admission and 2nd subgroup - patients with moderate hypertension. The type, volume, location were investigated by CT scan. Systolic blood pressure and neurological signs were recorded hourly on the flow sheets. Glasgow Coma Scale (GCS), NIHSS, Rankin and Barthel Index were established as the baseline data, after 1 week and 1 month later. Non-modifiable and modifiable risk factors were registered and statistically evaluated by SPSS-11.0.

Results:

In 1st subgroup neurological deterioration was found in 6 patients of HS (27 patients/ 37,5%) versus IS (14/16,6%). Mean baseline SBP during the treatment were 182 ± 13 and 133 ± 7 mmHg, respectively. 2nd subgroup revealed neurological deterioration in 9(12,5%) HS patients versus 10(11,9%) IS, 1- volume growth was seen in HS versus 3- IS patients, Mean baseline SBP and MAP were 182 ± 13 and 165 ± 12 mmHg respectively. Outcome Scales of 1st subgroup of HS showed significant improvement at 1 month against the 2nd subgroup (P = 0.001). In IS patients the 2 subgroup resulted better as compared to 1st subgroup at 1 month (P = 0.001).

Conclusions:

Aggressive lowering of high BP in HS found to have the positive effect on outcome (OR-p < o.o5) reducing the blood enhancement and rehemorrhage incidence(P = 0.001), improving the short-term outcome and quality of life in patients with ICH, while moderate hypertension much more better for IS outcome(OR, p < o.o5).

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