Open AccessAcute blood pressure levels and long‐term outcome in ischemic stroke
Author(s) -
Bager JohanEmil,
Hjalmarsson Clara,
Manhem Karin,
Andersson Bjorn
Publication year - 2018
Publication title -
brain and behavior
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.915
H-Index - 41
ISSN - 2162-3279
DOI - 10.1002/brb3.992
Subject(s) - medicine , hazard ratio , stroke (engine) , proportional hazards model , blood pressure , cardiology , acute stroke , confidence interval , mechanical engineering , tissue plasminogen activator , engineering
Objectives Elevated blood pressure ( BP ) is common in acute ischemic stroke, but its effect on outcome is not fully understood. We aimed to investigate the association of baseline BP and BP change within the first day after stroke with stroke severity, functional outcome, and mortality. Methods Patients admitted to hospital with acute ischemic stroke (IS) from 15 February 2005 through 31 May 2009 were consecutively included. Acute stroke severity and functional outcome at three and twelve months were investigated using multivariate regression analysis; the association between BP and all‐cause mortality at one, three, and twelve was investigated by Cox proportional hazard regression and Kaplan–Meier survival curves. Results A total of 799 patients (mean age 78.4 ± 8.0, 48% men) were included. Higher decreases in systolic and mean arterial blood pressure (Δ SBP and Δ MAP ) were associated with decreased 1‐month mortality (Δ SBP : hazard ratio, HR : 0.981; 95% CI : 0.968 – 0.994; p = .005), 3‐month mortality (Δ SBP : HR 0.989; 95% CI 0.981 – 0.998; p ‐value .014), and twelve‐month mortality (Δ SBP : HR 0.989; 95% CI 0.982 – 0.996; p ‐value .003). Stroke severity was associated with Δ MAP (B coefficient −.46, p ‐value .011). Higher SBP and MAP on admission were associated with better functional outcome at three ( SBP : OR 0.987; 95% CI 0.978 – 0.997; p ‐value .008 ‐ MAP : OR 0.985; 95% CI 0.971 – 1; p ‐value .046) and twelve ( SBP : OR 0.988; 95% CI 0.979 – 0.998; p ‐value .015 – MAP : OR 0.983; 95% CI 0.968 – 0.997; p ‐value .02) months. Conclusion In this elderly population, higher BP on arrival to the emergency room ( ER ) and decrease in BP after the patients’ arrival to the ward were associated with improved functional outcome and reduced mortality, respectively. These results may reflect a regulatory situation in which elevated initial blood pressure indicates adequate response to cerebral tissue ischemia while subsequent blood pressure decrease instead may be a consequence of partial, successful reperfusion.