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Blood Pressure as an Independent Prognostic Factor in Acute Ischemic Stroke

Published online by Cambridge University Press:  02 December 2014

Matt B. Jensen ,
Bongin Yoo ,
William R. Clarke ,
Patricia H. Davis  and
Harold P. Adams Jr.
Matt B. Jensen*
Affiliation:
Stroke Center, University of California, San Diego, San Diego, California
Bongin Yoo
Affiliation:
Department of Biostatistics, University of Iowa College of Public Health, Iowa City, Iowa, USA
William R. Clarke
Affiliation:
Department of Biostatistics, University of Iowa College of Public Health, Iowa City, Iowa, USA
Patricia H. Davis
Affiliation:
Department of Neurology, University of Iowa College of Medicine, Iowa City, Iowa, USA
Harold P. Adams Jr.
Affiliation:
Department of Neurology, University of Iowa College of Medicine, Iowa City, Iowa, USA
*
Stroke Center, University of California, San Diego, OPC 3rd Floor Suite 3, 200 W. Arbor Dr., San Diego, CA 92103-8466, USA
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Abstract:

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Background and Purpose:

Blood pressure is elevated in most patients during acute ischemic stroke, but the prognostic significance of this is unclear as the current data yield conflicting results.

Methods:

Admission blood pressure from the 1281 patients in the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) was analyzed for prognostic significance as well as the risk of hemorrhagic transformation. We also examined weighted-average blood pressure over seven days, and the impact of a 30% change in blood pressure in 24 hours. Patients with severe hypertension were excluded from the TOAST trial.

Results:

Increasing systolic blood pressure (SBP) on admission, but not diastolic (DBP) or mean arterial pressure (MAP) was predictive of poor outcome, but this effect was not significant after adjustment for other know prognostic factors. Increasing weighted-average SBP and MAP over seven days were predictive for poor outcome, but a 30% change in blood pressure over 24 hours was not.

Conclusions:

Admission blood pressure is not an independent prognostic factor in acute ischemic stroke, but the weighted-average of SBP and MAP over seven days probably does have predictive value with higher values having a worse prognosis. A prospective trial of blood pressure control during acute stroke is needed.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 33 , Issue 1 , February 2006 , pp. 34 - 38
Copyright
Copyright © The Canadian Journal of Neurological 2006

References

1. Rodgers, A, MacMahon, S, Gamble, G, Slattery, J, Sandercock, P, Warlow, C. Blood pressure and the risk of stroke in patients with cerebrovascular disease. BMJ. 1996;313:147.Google Scholar
2. PATS Collaborating Group. Post-stroke antihypertensive treatmentstudy: a preliminary result. Chin Med J. 1995;108:710–7.Google Scholar
3. The Heart Outcome Prevention Evaluation Study Investigators. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med. 2000;342:145–53.CrossRefGoogle Scholar
4. PROGRESS Collaborative Group. Randomised trial of aperindopril-based blood-pressure-lowering regimen among 6105 individuals with previous stroke or transient ischaemic attack. Lancet. 2001;358:1033–41.Google Scholar
5. LIFE study group. Cardiovascular morbidity and mortality in theLosartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomized trial against atenolol. Lancet. 2002;359:995–1003.Google Scholar
6. Jorgensen, HS, Nakayama, H, Christensen, HR, Raaschou, HO, Kampmann, JP, Olsen, TS. Blood pressure in acute stroke. Cerebrovasc Dis. 2002;13:204–9.Google Scholar
7. Britton, M, Carlsson, A, de Faire, U. Blood pressure course in patients with acute stroke and matched controls. Stroke. 1986;17:861–4.Google Scholar
8. Semplicini, A, Maresca, A, Boscolo, G, Sartori, M, Rocchi, R, Giantin, V, et al. Hypertension in acute ischemic stroke: a compensatory mechanism or an additional damaging factor? Arch Intern Med. 2003;163:211–6.Google Scholar
9. Bhalla, A, Wolfe, CDA, Rudd, AG. The effect of 24 h blood pressurelevels on early neurological recovery after stroke. J Int Med. 2001;250:121–30.CrossRefGoogle Scholar
10. Ahmed, N, Wahlgren, N. High initial blood pressure after acutestroke is associated with poor functional outcome. J Int Med. 2001;249:467–73.CrossRefGoogle Scholar
11. Christensen, H, Meden, P, Overgaard, K, Boysen, G. The course of blood pressure in acute stroke is related to the severity of the neurological deficits. Acta Neurol Scand. 2002;106:142–7.CrossRefGoogle Scholar
12. Leonardi-Bee, J, Bath, PMW, Phillips, SJ, Sandercock, PAG, for the IST Collaborative Group. Blood pressure and clinical outcomes in the International Stroke Trial. Stroke. 2002;33:1315–20.Google Scholar
13. Castillo, J, Leira, R, Garcia, MM, Serena, J, Blanco, M, Davalos, A. Blood pressure decrease during the acute phase of ischemic stroke is associated with brain injury and poor stroke outcome. Stroke. 2004;35:520–7.Google Scholar
14. Carlberg, B, Asplund, K, Hagg, E. The prognostic value of admission blood pressure in patients with acute stroke. Stroke. 1993;24:1372–5.Google Scholar
15. Robinson, T, Waddington, A, Ward-Close, S, Taub, N, Potter, J. The predictive role of 24-hour compared to casual blood pressure levels on outcome following acute stroke. Cerebrovasc Dis. 1997;7:264–72.Google Scholar
16. Chamorro, A, Vila, N, Ascaso, C, Elices, E, Schonewille, W, Blanc, R. Blood pressure and functional recovery in acute ischemic stroke. Stroke. 1998;29:1850–3.Google Scholar
17. Boreas, AMHP, Lodder, J, Kessels, F, de Leeuw, PW, Troost, J. Prognostic value of blood pressure in acute stroke. J Hum Hypertens. 2002;16:111–6.Google Scholar
18. Aslanyan, S, Fazekas, F, Weir, CJ, Horner, S, Lees, KR, for the GAIN International Steering Committee and Investigators. Effect of blood pressure during the acute period of ischemic stroke on stroke outcome: a tertiary analysis of the GAIN international trial. Stroke. 2003;34:2420–5.Google Scholar
19. Vlcek, M, Schillinger, M, Lang, W, Lalouschek, W, Bur, A, Hirschl, MM. Association between course of blood pressure within the first 24 hours and functional recovery after acute ischemic stroke. Ann Emerg Med. 2003;42:619–26.CrossRefGoogle ScholarPubMed
20. The Publications Committee for the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) Investigators. Low molecular weight heparanoid, ORG 10172 (danaparoid), and outcome after acute ischemic stroke: a randomized controlled trial. JAMA. 1998;279:1265–72.Google Scholar
21. Wahlgren, NG, Macmahon, DG, Dekeyser, J, Indredavik, B, Ryman, T. (INWEST) of nimodipine in the treatment of acute ischemicstroke. Cerebrovasc Dis. 1994;4:204–10.Google Scholar
22. Willmot, M, Leonardi-Bee, J, Bath, PMW. High blood pressure inacute stroke and subsequent outcome: a systematic review. Hypertension. 2004;43:18–24.CrossRefGoogle Scholar
23. Rordorf, G, Koroshetz, WJ, Ezzeddine, MA, Segal, AZ, Buonanno, FS. A pilot study of drug-induced hypertension for treatment of acute stroke. Neurology. 2001;56:1210–3.Google Scholar
24. Hillis, AE, Ulatowski, JA, Barker, PB, Torbey, M, Ziai, W, Beauchamp, NJ, et al. A pilot randomized trial of induced blood pressure elevation: effects on function and focal perfusion in acute and subacute stroke. Cerebrovasc Dis. 2003;16:236–46.Google Scholar
25. Adams, HP, Adams, RJ, Brott, T, del Zoppo, GJ, Furlan, A, Goldstein, LB, et al. Guidelines for the early management of patients with ischemic stroke: a scientific statement from the Stroke council of the American Stroke Association. Stroke. 2003;34:1056–83.Google Scholar
26. Kanji, S, Corman, C, Douen, AG. Blood pressure management inacute stroke: comparison of current guidelines with prescribing patterns. Can J Neurol Sci. 2002;29(2):125–31.Google Scholar
27. Schrader, J, Luders, S, Kulchewski, A, et al. The ACCESS Study:Evaluation of acute candesartan cilexetil therapy in stroke survivors. Stroke. 2003;34:1699–703.Google Scholar
28. Spence, JD. Hypertension and stroke. Can J Neurol Sci. 2002 May; 29(2):113–4.Google Scholar
29. Bath, P, Boysen, G, Donnan, G, et al. Hypertension in acute stroke:what to do? Stroke. 2001;32(7):1697–8.Google Scholar