The importance of blood pressure control in patients with ischaemic stroke in the acute period

Abstract

Cerebral stroke remains a major medical and social problem in Ukraine and worldwide, associated with a high incidence of morbidity, disability and mortality. In the structure of total cardiovascular mortality in our country, it ranks second after myocardial infarction. Objective — to investigate blood pressure fluctuations during the acute period of ischaemic stroke. Materials and methods. We monitored daily blood pressure fluctuations during the acute period of ischaemic stroke (IS) in 240 patients, including 140 men and 100 women aged 60 to 80 years. In 36 patients, the stroke was recurrent. Statistical processing of blood pressure monitoring was performed. Results. It has been established that in the first day of IS, regular blood pressure measurement is necessary, preferably by daily blood pressure monitoring. The frequency of measurement is determined by the severity of the patient and the level of blood pressure. On average, every 15 min for the first 2 hours, every 30 min for the next 6 hours, and then every hour for up to a day. We have established that an increase in blood pressure (systolic to 140—180 mm Hg) on the first day of IS has a relatively good prognosis in terms of recovery from the disease. It should be noted that in patients with IS and blood pressure of 140/90 mm Hg, the prognosis was worse. In addition, an increase in blood pressure of more than 180/100 mm Hg in patients with IS is also associated with a worse prognosis of neurological recovery than a moderate increase. At the same time, an increase in blood pressure for every 10 mm Hg (above 180 mm Hg) is associated with a 39 % risk of increased neurological deficit and a 22 % risk of poor recovery. Conclusions. Arterial hypertension in the majority of patients with acute­onset IS is associated with a reaction to the disease, hospitalisation (emotional stress), increased intracranial pressure, and an adaptive response to cerebral ischaemia. The use of antihypertensive drugs is indicated only in the case of excessively high blood pressure and in cases where patients are indicated to lower blood pressure (thrombolysis is planned).