Haemodynamic parameters in hypertensive patients following acute stroke and early outcome

Cardiac baroreceptor sensitivity (BRS) plays an important part in the short-term blood pressure control. It is recognised that impaired cardiac BRS, measured 72-hours post-ictus, predicts poor death/dependency in long-term. There is a suggestion that increased stiffness affecting baroreceptors in aortic arch and carotid artery may account for impaired cardiac BRS in acute stroke. However, the role of cardiac BRS and arterial stiffness in predicting early (2-week) death/dependency following acute stroke in subjects on pre-existing antihypertensive therapy is not known.;Central, rather than peripheral, arterial compliance is a better predictor of cardiac BRS. There is relationship between baseline cardiac BRS and central arterial stiffness and both are independent predictors of early (2-week) outcome following acute stroke.;This thesis evaluates their predictive role for early outcome in a subgroup of an ongoing trial, the Continue Or Stop post-Stroke Antihypertensive Collaborative Study (COSSACS).;Cardiac BRS and arterial stiffness are negatively correlated, though this relationship is not significant when adjusted for common confounders. Lower beat-to-beat mean arterial pressure (MAP) and central systolic blood pressure (SBP) in acute phase of stroke (<48 hours), but not cardiac BRS or arterial stiffness predict early outcome.;These findings have important implications for the management of acute stroke hypertension, including the continuation or discontinuation of pre-existing antihypertensive therapy, given the presence of cerebrovascular dysautoregulation following acute stroke. Randomised, controlled, intervention studies are ongoing to inform the management of this common problem.