Abstract. Vemmos KN, Tsivgoulis G, Spengos K, Zakopoulos N, Synetos A, Manios E, Konstantopoulou P, Mavrikakis M (University of Athens, 'Alexandra' Hospital; and University of Athens, 'Eginition' Hospital; Athens, Greece). U-shaped relationship between mortality and admission blood pressure in patients with acute stroke. J Intern Med 2004; 255: 257-265.Objective. To evaluate the relationship between systolic blood pressure (SBP) or diastolic blood pressure (DBP) on admission and early or late mortality in patients with acute stroke. Design. Prospective study of hospitalized first-ever stroke patients over 8 years. Setting. Stroke unit and medical wards in a University hospital. Subjects. A total of 1121 patients admitted within 24 h from stroke onset and followed up for 12 months. Main outcome measures. Mortality at 1 and 12 months after stroke in relation to admission SBP and DBP. Results. Early and late mortality in patients with acute ischaemic or haemorrhagic stroke in relation to admission SBP and DBP followed a 'U-curve pattern'. After adjusting for known outcome predictors, the relative risk of 1-month and 1-year mortality associated with a 10-mmHg SBP increase above 130 mmHg (U-point of the curve) increased by 10.2% (95% CI: 4.2-16.6%) and 7.2% (95% CI: 2.2-12.3%), respectively. For every 10 mmHg SBP decrease, below the U-point, the relative risk of 1-month and 1-year mortality rose by 28.2% (95% CI: 8.6-51.3%) and 17.5% (95% CI: 3.1-34.0%), respectively. Low admission SBP-values were associated with heart failure (P < 0.001) and coronary artery disease (P ¼ 0.006), whilst high values were associated with history of hypertension (P < 0.001) and lacunar stroke (P < 0.001). Death due to cerebral oedema was significantly (P ¼ 0.005) more frequent in patients with high admission SBP-values, whereas death due to cardiovascular disease was more frequent (P ¼ 0.004) in patients with low admission SBPvalues. Conclusion. Acute ischaemic or haemorrhagic stroke patients with high and low admission BP-values have a higher early and late mortality. Coincidence of heart disease is associated with low initial BP-values. Death due to neurological damage from brain oedema is associated with high initial BP-values.

Background and Purpose-Limited data exist concerning obesity and survival in patients after acute stroke. The objective of this study was to investigate the association between obesity and survival in patients with acute first-ever stroke. Methods-Patients were prospectively investigated based on a standard diagnostic protocol over a period of 16 years.Evaluation was performed on admission, at 7 days, at 1, 3, and 6 months after discharge, and yearly thereafter for up to 10 years after stroke. The study patients were divided into 3 groups according to body mass index (BMI): normal weight (Ͻ25 kg/m 2 ), overweight (25-29.9 kg/m 2 ), and obese (Ն30 kg/m 2 ). Overall survival during follow-up was the primary end point. The secondary end point was the overall composite cardiovascular events over the study period.Results-Based on our inclusion criteria, 2785 patients were recruited. According to BMI, 1138 (40.9%)

Renal function on admission appears to be a significant independent prognostic factor for long term mortality and new cardiovascular morbidity over a 10-year period.

Abstract-The extent of target-organ damage has been positively associated with the magnitude of blood pressure (BP) variability in essential hypertension. However, the clinical implications of the rate of BP changes have never been investigated. We evaluated the association between the rate of systolic BP (SBP) variation derived from ambulatory BP monitoring (ABPM) data analysis and the extent of common carotid artery (CCA) intima-media thickness (IMT) in normotensive (nϭ280) and in uncomplicated hypertensive subjects (nϭ234 Key Words: blood pressure Ⅲ carotid arteries Ⅲ blood pressure monitoring Ⅲ baroreflex Ⅲ ultrasonography P rospective studies in treated and untreated hypertensive patients and in the general population have demonstrated that even after adjusting for established risk factors, the incidence of cardiovascular events is correlated with blood pressure (BP) on conventional as well as ambulatory measurements. 1,2 However, ambulatory BP monitoring (ABPM) significantly refines the prediction already provided by office recordings because target-organ damage is more closely associated with ambulatory than clinic BP. 1,2 Intra-arterial beat-to-beat monitoring has shown that BP is highly variable. 3 Despite difficulties in the assessment of BP variability, particularly with noninvasive techniques, 4 evidence from cross-sectional 5-9 and longitudinal studies 10 -12 has suggested an independent and positive relationship between the extent of target-organ damage (measured by left ventricular mass, early carotid atherosclerosis, subcortical brain lesions, or a comprehensive end-organ damage score) and the magnitude of BP variability in essential hypertension. Besides, BP variability was an independent predictor for cardiovascular mortality in the general population. 13 Interestingly, Mancia et al reported recently that hypertensive patients compared with normotensive subjects present steeper fast-and short-duration beat-to-beat BP changes, documented by means of intra-arterial BP monitoring. 14 Furthermore, experimental studies have suggested that the traumatic effect of intravascular pressure on the vessel wall, which results in vascular remodeling and atherosclerosis, may be more closely associated to oscillatory than to steady laminar shear stress. [15][16][17] This evidence raises the issue of whether a hypertensive patient's prognosis depends not only on average BP level but, to some extent, also on the degree and rate of BP variation.However, the clinical implications of the time rate of noninvasive ambulatory BP changes have never been investigated in essential hypertension. Quantitative B-mode ultrasound imaging offers the opportunity to assess the intimamedia thickness (IMT) of the common carotid artery (CCA), which is considered a reliable marker for the extent of early atherosclerosis 18 and an indicator of the risk of cardiovascular diseases. 19 Moreover, Zanchetti et al reported that CCA-IMT