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Blood Pressure as an Independent Prognostic Factor in Acute Ischemic Stroke

Published online by Cambridge University Press:  02 December 2014

Matt B. Jensen ,
Bongin Yoo ,
William R. Clarke ,
Patricia H. Davis  and
Harold P. Adams Jr.
Matt B. Jensen*
Affiliation:
Stroke Center, University of California, San Diego, San Diego, California
Bongin Yoo
Affiliation:
Department of Biostatistics, University of Iowa College of Public Health, Iowa City, Iowa, USA
William R. Clarke
Affiliation:
Department of Biostatistics, University of Iowa College of Public Health, Iowa City, Iowa, USA
Patricia H. Davis
Affiliation:
Department of Neurology, University of Iowa College of Medicine, Iowa City, Iowa, USA
Harold P. Adams Jr.
Affiliation:
Department of Neurology, University of Iowa College of Medicine, Iowa City, Iowa, USA
*
Stroke Center, University of California, San Diego, OPC 3rd Floor Suite 3, 200 W. Arbor Dr., San Diego, CA 92103-8466, USA
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Abstract:

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Background and Purpose:

Blood pressure is elevated in most patients during acute ischemic stroke, but the prognostic significance of this is unclear as the current data yield conflicting results.

Methods:

Admission blood pressure from the 1281 patients in the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) was analyzed for prognostic significance as well as the risk of hemorrhagic transformation. We also examined weighted-average blood pressure over seven days, and the impact of a 30% change in blood pressure in 24 hours. Patients with severe hypertension were excluded from the TOAST trial.

Results:

Increasing systolic blood pressure (SBP) on admission, but not diastolic (DBP) or mean arterial pressure (MAP) was predictive of poor outcome, but this effect was not significant after adjustment for other know prognostic factors. Increasing weighted-average SBP and MAP over seven days were predictive for poor outcome, but a 30% change in blood pressure over 24 hours was not.

Conclusions:

Admission blood pressure is not an independent prognostic factor in acute ischemic stroke, but the weighted-average of SBP and MAP over seven days probably does have predictive value with higher values having a worse prognosis. A prospective trial of blood pressure control during acute stroke is needed.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 33 , Issue 1 , February 2006 , pp. 34 - 38
Copyright
Copyright © The Canadian Journal of Neurological 2006

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