***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background and Purpose — In patients with acute ischemic stroke , a high blood pressure or a highly variable blood pressure is a common reason for withholding thrombolytic treatment , but guidelines recommend a conservative approach to active blood pressure lowering in this setting . We have performed exploratory analyses to study the clinical effects of blood pressure and early blood pressure – lowering treatment in patients included in a r and omized-controlled trial of thrombolytic treatment for acute ischemic stroke . Methods — The Third International Stroke Trial ( IST-3 ) r and omized 3035 patients with ischemic stroke to recombinant tissue-type plasminogen activator 0.9 mg/kg or open control within 6 hours of symptom onset .  Blood pressure was measured at r and omization , at start of treatment , and at 30 minutes and 1 and 24 hours after start of treatment , and the use of blood pressure – lowering treatment during the first 24 hours was recorded . We have characterized blood pressure by mean systolic blood pressure at baseline , by variability of systolic blood pressure ( expressed by the st and ard deviation and the range between the lowest and the highest pressure ) , and by the change in systolic blood pressure from baseline to 24 hours . We used logistic regression analysis to explore the associations of blood pressure characteristics or blood pressure – lowering treatment with early adverse events , early death , and functional outcome at 6 months , after adjustment for key prognostic variables . Results — High baseline blood pressure and high blood pressure variability during the first 24 hours were associated with higher numbers of early adverse events and early deaths , and for several analyses , the differences were statistically significant . A larger decline in blood pressure and the use of blood pressure – lowering treatment during the first 24 hours were associated with a reduced risk of poor outcome at 6 months ( odds ratio , 0.93 ; 95 % confidence interval , 0.89–0.97 ; P=0.001 and odds ratio , 0.78 ; 95 % confidence interval , 0.65–0.93 ; P=0.007 , respectively ) , irrespective of whether the patient was given recombinant tissue-type plasminogen activator ( P values for interaction > 0.05 ) . Conclusions — Among patients with ischemic stroke who are c and i date s for thrombolytic treatment , high baseline blood pressure and a large pressure variability during the first 24 hours may be associated with a poor prognosis , whereas a large reduction in blood pressure and the use of blood pressure – lowering treatment during the first 24 hours may be associated with a favorable prognosis . These data support the rationale for further trials of agents that lower blood pressure or reduce blood pressure variability in the acute phase of ischemic stroke . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT00120003 Background and Purpose The etiology of ischemic stroke affects prognosis , outcome , and management . Trials of therapies for patients with acute stroke should include measurements of responses as influenced by subtype of ischemic stroke . A system for categorization of subtypes of ischemic stroke mainly based on etiology has been developed for the Trial of Org 10172 in Acute Stroke Treatment ( TOAST ) . Methods A classification of subtypes was prepared using clinical features and the results of ancillary diagnostic studies . “ Possible ” and “ probable ” diagnoses can be made based on the physician 's certainty of diagnosis . The usefulness and interrater agreement of the classification were tested by two neurologists who had not participated in the writing of the criteria . The neurologists independently used the TOAST classification system in their bedside evaluation of 20 patients , first based only on clinical features and then after review ing the results of diagnostic tests . Results The TOAST classification denotes five subtypes of ischemic stroke : 1 ) large-artery atherosclerosis , 2 ) cardioembolism , 3 ) small-vessel occlusion , 4 ) stroke of other determined etiology , and 5 ) stroke of undetermined etiology . Using this rating system , interphysician agreement was very high . The two physicians disagreed in only one patient . They were both able to reach a specific etiologic diagnosis in 11 patients , whereas the cause of stroke was not determined in nine . Conclusions The TOAST stroke subtype classification system is easy to use and has good interobserver agreement . This system should allow investigators to report responses to treatment among important subgroups of patients with ischemic stroke . Clinical trials testing treatments for acute ischemic stroke should include similar methods to diagnose subtypes of stroke BACKGROUND Previous studies on the association between blood pressure ( BP ) variability in acute ischemic stroke and functional outcomes have yielded conflicting results . We aim ed to investigate the predictive significance of day-to-day BP variability during the 7 days following stroke onset for functional outcomes at 12 months . METHODS A total of 229 patients ( male 68.8 % , mean age 66.7 ± 13.0 years ) within 24 hours after onset were prospect ively studied . The first 24 hours and day-to-day BP variability , including the SD , coefficient variation ( CV ) , average real variation , and ΔBP ( difference between the maximum and minimum BP ) , were derived and compared to functional outcomes . The functional outcomes were accessed using the baseline severity-adjusted analysis at 12 months post-stroke . RESULTS The patients with poor outcomes at 12 months had significantly higher morning systolic BP ( SBP ; 1 - 3 days after onset ) than those with good outcomes . The day-to-day SBP variability parameters ( 1 - 7 days ) such as SD , CV , and Δ SBP were significantly higher in the patients with poor outcomes than in those with good outcomes ( 17.0 ± 6.0 vs. 14.8 ± 5.3 mm Hg , 11.8 ± 3.9 vs. 10.6 ± 3.5 , 48.3 ± 17.7 vs. 39.9 ± 15.5 mm Hg , respectively ; P < 0.05 ) . After adjustment for demographic and clinical features , day-to-day Δ SBP was associated with poorer functional outcomes at 12 months ( odds ratio , 95 % confidence interval : 1.547 , 1.097 - 2.181 ) . Even after adjusting for the mean SBP , Δ SBP was independently associated with 12-month poor functional outcomes ( odds ratio , 95 % confidence interval : 1.577 , 1.095 - 2.272 ) . CONCLUSIONS Day-to-day SBP variability in acute ischemic stroke was associated with poor functional outcomes at 12 months . CLINICAL TRIALS REGISTRATION Trial Number NCT02675972 Background and Purpose — Certain characteristics of early blood pressure ( BP ) profiles were reported to be independent predictors of long-term outcome in the first European Cooperative Acute Stroke Study ( ECASS-I ) trial . The aim of the study was to find out the association of BP profiles with functional outcome , mortality , and hemorrhagic complications in the ECASS-II data base . Methods — We studied 793 patients with acute ischemic hemispheric stroke in the ECASS-II . After r and omization  , BP was measured every 15 minutes during the first 2 hours , then every 30 minutes during the first 8 hours , and thereafter at 1-hour intervals up to 24 hours . Individual 0- to 24-hour BP profiles were characterized by baseline , maximum , minimum , and mean BP and successive variation of the profile . The end points were favorable outcome ( modified Rankin Scale score of 0 or 1 ) at day 90 , all-cause mortality at day 90 , and hemorrhagic transformation within the first 7 days . Results — High baseline , maximum , mean level , and variability of systolic BP profiles were each inversely associated with favorable outcome ( OR=0.84 , 95 % CI : 0.74 to 0.94 ; OR=0.82 , 95 % CI : 0.73 to 0.91 ; OR=0.81 , 95 % CI : 0.71 to 0.93 ; OR=0.57 , 95 % CI : 0.35 to 0.92 , respectively ) and associated with an increased risk of parenchymal hemorrhage within the first 7 days ( OR=1.27 , 95 % CI : 1.07 to 1.51 ; OR=1.49 , 95 % CI : 1.27 to 1.75 ; OR=1.52 , 95 % CI : 1.23 to 1.87 ; OR=2.62 , 95 % CI : 1.40 to 4.87 ; respectively ) in recombinant tissue plasminogen activator-treated patients . In placebo-treated patients , high maximum , mean level , and successive variation of systolic BP profiles were inversely associated with favorable outcome ( OR=0.76 , 95 % CI : 0.66 to 0.86 ; OR=0.76 , 95 % CI : 0.65 to 0.89 ; OR=0.41 , 95 % CI : 0.22 to 0.76 ; respectively ) , although the association of baseline systolic BP and favorable outcome was not significant ( OR=0.91 , 95 % CI : 0.80 to 1.03 ) . No association with hemorrhagic transformation was found , even after the adjustment . Conclusions — The hemorrhagic transformation within the first 7 days and favorable outcome were independently associated with dynamics of BP within the first 24 hours after an acute ischemic stroke in patients treated with thrombolysis  , but in  placebo-treated patients , only with favorable outcome . Continuous BP monitoring is hence important for the prognosis and gives implication s to optimize BP management , particularly regarding a reasonable BP level and stability Background and Purpose The Oxfordshire Community Stroke Project ( OCSP ) clinical classification of subtypes of cerebral infa rct ion ( total and partial anterior circulation infa rct ion , lacunar infa rct ion , and posterior circulation infa rct ion ) can be used to predict early mortality , functional outcome , and whether the infa rct was likely due to large- or small-vessel occlusion . The OCSP classification was originally developed and tested by neurologists as part of a community-based study of first-ever stroke , in which some cases were seen after the acute phase . We examined the interobserver reliability of the classification when used in everyday clinical practice in patients seen during the acute phase of stroke shortly after admission to the hospital . Methods Two clinicians independently assessed consecutive patients admitted to the hospital with an acute stroke and recorded both the neurological features  and  their opinion  of the subtype of infa rct . Results Eighty-five patients were assessed .  Interobserver agreement for the classification was moderate to good ( k=0.54 ; 95 % confidence interval , 0.39 to 0.68 ) . Differences in the assessment of the commonly elicited neurological signs explained many of the disagreements : interobserver agreement was good for some signs ( hemiparesis [ k=0.77 ] , dysphasia [ k=0.70 ] ) , moderate for some ( hemianopia [ k=0.39 ] ) , and poor for others ( sensory loss [ k=0.15 ] ) . Conclusions The classification was simple and practicable ( and could be widely used in routine clinical practice , r and omized controlled trials , and audit ) , and interobserver reliability was satisfactory OBJECTIVE Blood pressure variation is one of the factors that affects the risk of stroke recurrence and prognosis . This study investigates the effects of calcium channel blockers and beta-blockers on blood pressure variability in severe ischemic stroke patients . PATIENTS AND METHODS The clinical data of 24 patients with ischemic stroke in our intensive care unit were analyzed , and received amlodipine or metoprolol for more than 14 days with 24-hour ambulatory blood pressure monitoring .  All patients aged 61 - 90 years , with GCS score ≤ 8 or associated with other organ dysfunction . RESULTS Among these 24 ischemic stroke patients , 12 received amlodipine and 12 received metoprolol . The observation period was divided into two phases : 1 - 6 days and 7 - 14 days . The decrease in blood pressure was faster in the metoprolol group than in the amlodipine group , while the average st and ard deviation was significantly greater and the smoothness index was less . CONCLUSIONS Metoprolol has faster onset  than amlodipine  and less blood pressure variability than metoprolol Background : The authors previously reported a low initial emergency department ( ED ) blood pressure ( BP ) to be associated with a significantly increased risk of death at 90 days . In this article , they examine the impact of acute BP variability following onset of ischemic stroke . Methods : The study cohort consisted of 71 patients with stroke onset less than 24 hours .  BP measurements were obtained every 5 minutes for the duration of the patient ’s ED stay . During the first 180 minutes , the median number of readings per patient was 9 ( range 2 to 30 ) . Results : The baseline median systolic ( sBP ) and diastolic ( dBP ) BPs were not different for the patients that died within 90 days compared with those that were alive ( p = 0.91 for sBP and p = 0.27 for dBP ) . Patients who died within 90 days had a greater differential in their dBP during the first 180 minutes than the patients that were alive after 90 days ( median 44.5 vs 25 mm Hg ; Wilcoxon rank 
    Output:
    
However , increased BPV is associated with adverse long-term outcomes .