Stroke In Hypertensive Patients Research Articles

Effects of arotinolol on regional cerebral blood flow in hypertensive patients with a history of stroke

AbstractAlthough optimal blood pressure control is important for managing stroke patients, the use of antihypertensives in stroke patients often causes cerebral blood flow reduction leading sometimes to deterioration of symptoms. Effects of arotinolol, a β‐blocker with a moderate α‐blocking action, on the regional cerebral blood flow (rCBF) were investigated in 10 hypertensive patients with a history of stroke by using a noninvasive 133Xe inhalation method. The rCBF was measured before and after administration of 15 mg/day arotinolol (three times a day) for 2–3 weeks. After the administration, the blood pressure was reduced in all the patients showing a change in average values of from 176/105 mmHg to 152/90 mmHg. The rCBF in the infarcted and healthy hemispheres was 44.3 ± 4.4 and 44.6 ± 5.0 ml/100 g/min before arotinolol and 44.9 ± 6.4 and 45.3 ± 6.5 ml/100 g/min after arotinolol, respectively. No significant rCBF change was observed after arotinolol in both hemispheres. During the administration, none of the patients suffered from dizziness or other ischemic symptoms. The above results suggest that arotinolol exerts little influence on the cerebral circulation and may be useful for the management of hypertension in stroke patients.

Cerebrovascular events in the Hypertension Detection and Follow-up Program

T HIS ARTICLE focuses on the 5-year occurrence of fatal and nonfatal stroke in the Hypertension Detection and Follow-up Program (HDFP) Stepped Care (SC) and Referred Care (RC) hypertensive participants. A number of clinical trials of hypertension have reported reductions in fatal and nonfatal stroke in hypertensive patients receiving antihypertensive treatment.‘” This was true in the HDFP also, where the dramatic effect of SC therapy provided by the special hypertension clinics was observed in the reduction of 5-year fatal and nonfatal stroke as compared with RC, where less aggressive antihypertensive treatment was provided by community sources.

Cerebral Infarction in Hypertensive and Nonhypertensive Subjects in a Community of Japan: The Hisayama Study

To compare the clinical features associated with stroke in hypertensive pa tients with those in nonhypertensives, we analyzed the records and the autopsy findings of cases of cerebral infarction in the Hisayama prospective study from 1961 through 1973. Of the total 128 cases of cerebral infarction, 79 (61.7%) occurred in patients admitted as hypertensives. In addition, of the 17 normotensive subjects at entry, (29.4%) had blood pressure levels that shifted into the hypertension range while 13 of 18 (72.2%) with borderline hypertension at entry had blood pressure levels that changed into the hypertensive range before stroke. In reviewing clinical symptoms and autopsy findings we frequently found that small, deep cerebral infarction, most often located in basal ganglia, in hy pertensive old persons. On the other hand, arrhythmia on ECG and focal in farcts on sytemic organs of the body were more often found in nonhypertensive patients with cerebral infarction than in hypertensives. This suggested that em bolism of cardiac origin may at least contribute to the development. of cerebral infarction in nonhypertensive subjects.

The relation between cardiac function and cerebral blood flow in stroke patients. 1. Effect of CO 2 inhalation.

The effects of CO 2 inhalation were determined on 23 stroke patients with and without hypertension who underwent clinical, cardiohemodynamic, cerebral blood flow (hemispheric mean and regional), cerebral metabolic rate and cerebral angiographical studies. Cardiac output, heart rate, systemic and pulmonary arterial blood pressures and cardiac work rose in essentially all patients during CO 2 inhalation, and fell to below baseline levels in approximately half of the patients studied after CO 2 , inhalation was discontinued. Baseline cardiac output was normal in normotensive stroke patients without cardiac dysfunction, but was low in hypertensive stroke patients. A statistically significant increase in cerebral blood flow occurred during CO 2 , inhalation, with an observed decrease in cerebrovascular resistance. The percentage increase in cerebral blood flow exceeded the increase in cardiac output. Since hypercarbia causes a rise in systemic and pulmonary arterial blood pressure, CO 2 inhalation should be used cautiously in patients with systemic or pulmonary hypertension. The rise in cardiac work during CO 2 inhalation could jeopardize patients with coronary heart disease and those with heart failure. Following cessation of CO 2 inhalation, blood pressure and cardiac output may fall below baseline levels, with a risk of posthypercapnic fall in cerebral blood flow. Occasionally, cardiac arrhythmia occurs during or following CO 2 inhalation.

Hypertension and Strokes.

Excerpt This study examines the relationship of hypertension in stroke patients in regards to age, sex, incidence, and mortality. A record review was made of 120 black indigent stroke patients. Age...