U‐shaped relationship between mortality and admission blood pressure in patients with acute stroke

Vemmos, Konstantinos; Tsivgoulis, Georgios; Spengos, Konstantinos; Zakopoulos, Nikolaos; Synetos, Αndreas; Manios, Efstathios; Konstantopoulou, Pinelopi; Mavrikakis, Myron

doi:10.1046/j.1365-2796.2003.01291.x

Cited by 339 publications

(244 citation statements)

References 28 publications

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“…A U‐shaped relationship between admission BP and early and late death has been shown, suggesting that both high and low BPs are detrimental (Leonardi‐Bee et al., 2002; Vemmos et al., 2004). Wohlfahrt et al.…”

Section: Introductionmentioning

confidence: 99%

Acute blood pressure levels and long‐term outcome in ischemic stroke

et al. 2018

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ObjectivesElevated 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.MethodsPatients 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.ResultsA total of 799 patients (mean age 78.4 ± 8.0, 48% men) were included. Higher decreases in systolic and mean arterial blood pressure (ΔSBP and ΔMAP) were associated with decreased 1‐month mortality (ΔSBP: hazard ratio, HR: 0.981; 95% CI: 0.968 – 0.994; p = .005), 3‐month mortality (ΔSBP: HR 0.989; 95% CI 0.981 – 0.998; p‐value .014), and twelve‐month mortality (ΔSBP: HR 0.989; 95% CI 0.982 – 0.996; p‐value .003). Stroke severity was associated with ΔMAP (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.ConclusionIn 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.

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Section: Introductionmentioning

confidence: 99%

Acute blood pressure levels and long‐term outcome in ischemic stroke

et al. 2018

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“…However, the occurrence of stroke may directly lead to an acute increase in BP 4, 5. Although the role of BP management after a stroke remains controversial, systolic, mean, or diastolic BP levels upon hospital arrival have demonstrated a U‐ or J‐curve association with poststroke mortality and functional dependency 6, 7, 8, 9, 10, 11, 12…”

Section: Introductionmentioning

confidence: 99%

Low Pulse Pressure After Acute Ischemic Stroke is Associated With Unfavorable Outcomes: The Taiwan Stroke Registry

Tang

Yin

Liu

et al. 2017

JAHA

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BackgroundPulse pressure (PP) is related to cardiac function, arterial stiffness, fluid status, and vascular events. This study aimed to explore the prognostic role of PP upon admission in patients with acute ischemic stroke (AIS) based on a nation‐wide stroke registry.Methods and ResultsWe evaluated the association between PP upon admission and outcomes 3 months after a stroke in patients who had an AIS registered in the Taiwan Stroke Registry, including 56 academic and community hospitals between 2006 and 2013. Three months after the stroke, unfavorable outcomes were defined using a modified Rankin scale of 3 to 6. Of 33 530 patients (female, 40.6%; mean age, 68.8±13.3 years) who had an AIS, PP upon admission had a reverse J‐curve association with an unfavorable outcome. After adjusting for clinical variables, including AIS subtypes, initial National Institutes of Health Stroke Scale, and systolic and diastolic blood pressure upon admission, a PP of <50 mm Hg was associated with unfavorable outcomes (P<0.0001). Compared with patients with a PP of 50 to 69 mm Hg, the odds ratios for unfavorable outcomes were 1.24 (95% CI, 1.14–1.36) with a PP of 30 to 49 mm Hg and 1.85 (95% CI, 1.50–2.28) with a PP of <30 mm Hg. Moreover, the prognostic impact of PP upon admission was similar across all AIS subtypes.ConclusionsLow PP upon admission was associated with unfavorable patient outcomes in AIS.

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“…There was spontaneous reduction of blood pressure (an average of 20 mm Hg systolic and 10 mm Hg diastolic) within ten days following the acute event without any specific antihypertensive therapy, with only one third of the cases remaining hypertensive on the tenth day of hospitalization. Subsequently, several other studies [2][3][4][5][6][7][8] have also described elevation of blood pressure in the acute period of stroke. In a systematic review of 18 studies [9], 52% of the patients with stroke had elevated blood pressure at the time of admission.…”

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confidence: 98%

“…In a systematic review of 18 studies [9], 52% of the patients with stroke had elevated blood pressure at the time of admission. Further studies have evaluated the prognostic significance of the initial elevated blood pressure observed in stroke patients [2][3][4][5][6][7][8]. Either lower or higher blood pressure after ischemic stroke and higher blood pressure after intracerebral hemorrhage were found to be associated with poor outcomes [5,6].…”

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confidence: 99%

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

Qureshi¹,

Ezzeddine²,

Nasar³

et al. 2007

The American Journal of Emergency Medicine

390

245

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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.

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U‐shaped relationship between mortality and admission blood pressure in patients with acute stroke

Cited by 339 publications

References 28 publications

Acute blood pressure levels and long‐term outcome in ischemic stroke

Acute blood pressure levels and long‐term outcome in ischemic stroke

Low Pulse Pressure After Acute Ischemic Stroke is Associated With Unfavorable Outcomes: The Taiwan Stroke Registry

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

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