Vasoactive drugs for acute stroke.
Chamila Geeganage1, Philip Mw Bath
1Division of Stroke Medicine, University of Nottingham, Nottingham City Hospital Campus, Hucknall Road, Nottingham, UK, NG5 1PB.
The Cochrane Database of Systematic Reviews
|July 9, 2010
Summary
Altering blood pressure (BP) in acute stroke is not well-supported by evidence. While some drugs lower BP, diaspirin cross-linked hemoglobin (DCLHb) increased poor outcomes, suggesting caution with BP-raising agents.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Clinical Pharmacology
Background:
- The management of blood pressure (BP) during the acute phase of stroke remains uncertain.
- Optimal BP targets and interventions require further investigation.
Purpose of the Study:
- To evaluate the impact of modifying blood pressure (BP) in patients experiencing acute stroke.
- To assess the effects of various vasoactive medications on BP levels in acute stroke.
Main Methods:
- A systematic review of randomized controlled trials was conducted, searching multiple databases up to October 2009.
- Included trials involved interventions expected to alter BP in patients within one week of acute stroke onset.
- Data from 43 trials involving 7649 patients were analyzed.
Main Results:
- Beta receptor antagonists, calcium channel blockers (CCBs), nitric oxide donors, and prostacyclin effectively lowered BP in acute stroke.
- Diaspirin cross-linked hemoglobin (DCLHb) significantly increased BP.
- Only DCLHb demonstrated a significant impact on outcomes, worsening combined death or dependency.
Conclusions:
- Insufficient evidence exists to reliably determine the effects of altering BP on outcomes following acute stroke.
- Treatment with DCLHb is associated with adverse clinical outcomes.
- Specific BP-lowering agents like beta receptor antagonists and CCBs reduced BP during acute stroke, but their impact on overall outcomes needs further study.
Related Concept Videos
01:29Hemorrhagic Stroke ll: Pathophysiology
A hemorrhagic stroke develops when a cerebral blood vessel ruptures, allowing blood to escape into the surrounding brain tissue, as in intracerebral hemorrhage (ICH), or into the subarachnoid space, as in subarachnoid hemorrhage (SAH). Because the skull is a rigid compartment, the sudden presence of extravascular blood rapidly increases intracranial pressure and compresses adjacent neural structures, leading to immediate tissue injury and impaired cerebral perfusion.Mass Effect and Primary...
01:23Antihypertensive Drugs: Vasodilators
Vasodilators, primarily affecting the smooth muscles within arterial and venous walls, are commonly used for hypertension treatment. Medications such as minoxidil and hydralazine primarily target arteries and arterioles, while sodium nitroprusside acts on arterioles and venules. Minoxidil, functioning as a prodrug, is metabolized by hepatic sulfotransferase into its active form, minoxidil sulfate, after oral administration. This metabolite binds to the sulfonylurea receptor (SUR) component of...
01:15Ischemic Stroke l: Introduction
Ischemic stroke is an acute cerebrovascular condition in which blood flow to a brain region is suddenly interrupted, leading to tissue infarction. Neurons depend on continuous oxygen and glucose supply, so even brief reductions in perfusion cause energy failure, ionic imbalance, and irreversible injury. Ischemic strokes are classified into thrombotic and embolic types based on their underlying mechanisms.Thrombotic MechanismsThrombotic stroke develops when a clot forms within a cerebral artery.
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
01:17Hemorrhagic Stroke l: Introduction
A hemorrhagic stroke is an acute neurological event that occurs when a weakened cerebral blood vessel ruptures, allowing blood to accumulate within or around the brain. The sudden release of blood forms a focal hematoma that increases intracranial pressure, displaces neural tissue, and can obstruct cerebrospinal fluid pathways. These effects may be compounded by intraventricular extension of the hemorrhage, cerebral edema, or compression of adjacent structures, all of which contribute to...
01:15Ischemic Stroke ll: Pathophysiology
An ischemic stroke occurs when a cerebral blood vessel becomes obstructed, most often by a thrombus or embolus, interrupting the delivery of oxygen and glucose to brain tissue. Because neurons rely on continuous aerobic metabolism, energy failure begins within minutes of reduced perfusion. The region receiving the least blood flow becomes the infarct core, an area of irreversible cellular death. Surrounding this core lies the penumbra, a zone of hypoperfused but still viable tissue that is...