Relationship Between Hyperacute Blood Pressure and Outcome After Ischemic Stroke

Abstract

Background and Purpose-High blood pressure (BP) is associated independently with poor outcome after acute ischemic stroke, although in most analyses "baseline" BP was measured 24 hours or more postictus, and not during the hyperacute period. Methods-Analyses included 1722 patients in hyperacute trials (recruitment Ͻ8 hours) from the Virtual Stroke International Stroke Trial Archive (VISTA) Collaboration. Data on BP at enrolment and after 1, 2, 16, 24, 48, and 72 hours, neurological impairment at 7 days (NIHSS), and functional outcome at 90 days (modified Rankin scale) were assessed using logistic regression models, adjusted for confounding variables; results are for 10-mm Hg change in BP. Results-Mean time to enrolment was 3.7 hours (range 1.0 to 7.9). High systolic BP (SBP) was significantly associated with increased neurological impairment (odds ratio, OR 1.06, 95% confidence interval, 95% CI 1.01 to 1.12), and poor functional outcome; odds ratios for both increased with later BP measurements made at up to 24 hours poststroke. Smaller (versus larger) declines in SBP over the first 24 hours were significantly associated with poor NIHSS scores (OR 1.16, 95% CI 1.05 to 1.27) and functional outcome (OR 1.23, 95% CI 1.13 to 1.34). A large variability in SBP was also associated with poor functional outcome. Conclusions-High SBP and large variability in SBP in the hyperacute stages of ischemic stroke are associated with increased neurological impairment and poor functional outcome, as are small falls in SBP over the first 24 hours.

Treating Hypertension in Acute Ischemic Stroke

“…Large falls in blood pressure or increases in blood pressure were associated with a higher risk of poor outcomes. Similarly, the authors of the Virtual International Stroke Trial Archive collaboration 8 recently found that high systolic pressures, a small drop in systolic pressure, and large variability in systolic pressure were associated with poor outcomes.…”

Prehospital systolic blood pressure is higher in acute stroke compared with stroke mimics

“…Elevated hospital admission blood pressure (BP) in patients with acute stroke is common 1 and is associated with poor outcomes. [2][3][4][5] There is limited randomized clinical trial evidence that acute BP reduction improves outcomes after intracerebral hemorrhage (ICH). …”

“…[2][3][4][5] There is limited randomized clinical trial evidence that acute BP reduction improves outcomes after intracerebral hemorrhage (ICH). 6 One of the hypothesized reasons for the modest treatment effect is that hematoma enlargement and clinical deterioration have already begun by the time antihypertensive therapy is administered.…”

Blood pressure variability and hemorrhagic transformation after intravenous thrombolysis in acute ischemic stroke

“…Regardless of t-PA injection, a larger difference in SBP and DBP during the acute phase of ischemic stroke is associated with reduced survival after 3 months 15 , and worsened neurological symptoms within 7 days of admission 16 . Although the measurement method, timing, mathematical calculation of the blood pressure, as well as measures of the patient's prognosis, differed among these studies, the common claim in these papers is that changes in blood pressure are associated with patient's prognosis.…”