How can integrative physiology advance stroke research and stroke care?

Abstract

Despite clear recent advances in stroke research and stroke care, many important questions remain unanswered. For example, what is optimal blood pressure treatment in stroke? This one question will likely receive many new questions in return. Do we mean optimal blood pressure treatment in the acute phase of stroke, or in the context of secondary prevention of stroke? Do we mean ischemic stroke, ICH, or SAB? Does it concern blood pressure treatment around thrombolysis or thrombectomy? Is the goal of treatment to prevent bleeding (through hyperperfusion or increased intracranial pressure), or is it to prevent ischemia (hypoperfusion)? When we think of optimal blood pressure control in such different settings, even other questions may come to mind. Blood pressure is acutely elevated in acute stroke. What is the mechanism behind this, and does it perhaps serve a purpose? Does the brain initiate this rise in blood pressure to maintain perfusion, and will blood pressure lowering treatment lead to hypoperfusion? We cannot, and should not, answer these questions without integrative physiology.