Prevalence of elevated blood pressure in 563704 adult patients with stroke presenting to the ED in the United States

Abstract

Purpose-To estimate the prevalence of elevated blood pressure in adult patients with acute stroke in the United States (U.S.).Methods-Stroke patients were classified by initial systolic blood pressure into four categories using demographic, clinical, and treatment data from the National Hospital Ambulatory Medical Care Survey, the largest study of utilization and provision of emergency department services in the U.S. We also compared the age-, sex-, and ethnicity-adjusted rates of elevated blood pressure strata comparable with stages 1 and 2 hypertension in the U.S. population.Results-Of the 563,704 stroke patients evaluated, initial systolic blood pressure was <140 mm Hg in 173,120 patients (31%), 140-184 mm Hg in 315,207 patients (56%), 185-219 mm Hg in 74,586 patients (13%), and ≥220 mm Hg in 791 patients (0.1%). The mean time interval between presentation and evaluation was 40 ± 55, 33 ± 39, 25 ± 27, and 5 ± 1 minutes for increasing systolic blood pressure strata (p=0.009). A 3-and 8-fold higher rate of elevated blood pressure strata was observed in acute stroke than the existing rates of stages 1 and 2 hypertension in the U.S. population. Labetalol and hydralazine were used in 6,126 (1%) and 2,262 (0.4%) patients, respectively. Thrombolytics were used in 1,283 patients (0.4%), but only in those with SBP of 140-184 mm Hg.Conclusions-In a nationally representative large dataset, elevated blood pressure was observed in over 60% of the patients presenting with stroke to the emergency department. Elevated blood pressure was associated with an earlier evaluation, however, the use of thrombolytics was restricted to ischemic stroke patients with systolic blood pressure <185 mm Hg.

Mimics and chameleons in stroke

“…In a large American dataset of 276,734 patients with acute ischaemic stroke, nearly 50% of patients had a systolic or diastolic blood pressure greater than or equal to 160 mmHg or 100 mmHg, respectively. 32 The most likely causes of neurological deficits in the context of hypertension are ischaemic or haemorrhagic stroke and, less frequently, hypertensive encephalopathy or posterior reversible encephalopathy syndrome. The latter usually presents in a more sub-acute fashion with varying clinical symptoms, including seizures, encephalopathy, headache and visual disturbance.…”

An Echocardiographic Study in Patients with Non Haemorrhagic Cerebral Infarction to Find Cardiac Abnormalities

“…In a study by Qureshi et al [14] elevated blood pressure was found in over 60% of patients. In the present study hypertension was found to be a present in 50% of the cases which is comparable to The Oxfordshire community stroke project by Sandercock P et al [15] in which prevalence of hypertension was found in 52% of cases of cerebral infarction.…”

Blood Pressure Control in Neurological ICU Patients: What is Too High and What is Too Low?

“…The blood pressure is elevated in 56-100 % of patients during the acute phase of a SAH [24]. Although evidence demonstrating an association between increased BP and aneurysm rebleeding is limited [25,26], one study suggested that SBP greater than 160mmHg is a risk factor for rebleeding in the acute phase of SAH [27].…”