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Blood Pressure and Early Clinical Outcome Among Acute Ischemic Stroke Patients

Published online by Cambridge University Press:  02 December 2014

Jintao Zhang ,
Ying Peng ,
Huanqing Fan ,
Mei Chen ,
Tan Xu  and
Yonghong Zhang
Jintao Zhang
Affiliation:
Department of Neurology, The 88th Hospital of PLA, Taian, Shandong Province
Ying Peng
Affiliation:
Department of Epidemiology, School of Radiation Medicine and Public Health, Medical College of Soochow University, Suzhou, China
Huanqing Fan
Affiliation:
Department of Neurology, The 88th Hospital of PLA, Taian, Shandong Province
Mei Chen
Affiliation:
Department of Epidemiology, School of Radiation Medicine and Public Health, Medical College of Soochow University, Suzhou, China
Tan Xu
Affiliation:
Department of Epidemiology, School of Radiation Medicine and Public Health, Medical College of Soochow University, Suzhou, China
Yonghong Zhang*
Affiliation:
Department of Epidemiology, School of Radiation Medicine and Public Health, Medical College of Soochow University, Suzhou, China
*
Department of Epidemiology, School of Radiation Medicine and Public Health, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Post Code: 215123, Suzhou, China
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Abstract:

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Objectives:

The association between blood pressure (BP) and short-term clinical outcome of acute ischemic stroke is inconclusive. We investigated the association between BP in the first 72 hours following admission and death in-hospital and neurologic deficiency at discharge among patients with acute ischemic stroke.

Methods:

A total of 2675 acute ischemic stroke patients confirmed by a computed tomography scan or magnetic resonance imaging were included in the present study. Blood pressure in the first 72 hours after admission and other study variables were collected for all ischemic stroke patients. Neurological functions National Institute of Health Stroke Scale (NIHSS) were evaluated by trained neurologists at discharge. The study outcome was defined as death in-hospital and neurologic deficiency (NIHSS≥10) at discharge.

Results:

Systolic and diastolic BP were significantly and positively associated with odds of study outcome in acute ischemic stroke. For example, compared to those with a systolic BP<140 mmHg, multiple-adjusted odds ratio (95% confidence interval) of study outcome was 3.29(1.22, 8.90) among participants with systolic BP of 180-219 mmHg, P<0.05; compared to those with a diastolic BP<90 mmHg, multiple-adjusted odds ratio of study outcome was 7.05(1.32, 37.57) among participants with diastolic BP ≥ 120 mmHg, P<0.05.

Conclusion:

Systolic BP≥180 and diastolic BP≥120 were significantly and positively associated with death in-hospital or neurologic deficiency at discharge among patients with acute ischemic stroke.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 38 , Issue 2 , March 2011 , pp. 225 - 229
Copyright
Copyright © The Canadian Journal of Neurological 2011

References

1WHO. Global burden of disease 2002; deaths by age, sex and cause for the year 2002. Geneva, Switzerland: World Health Organization; 2003.Google Scholar
2Yusuf, S, Reddy, S, Ounpuu, S, Anand, S.Global burden of cardiovascular diseases. Part II: variations in cardiovascular disease by specific ethnic groups and geographic regions and prevention strategies. Circulation. 2001;104(23):2855–64.Google Scholar
3He, J, Gu, D, Wu, X, et al.Major causes of death among men and women in China. N Engl J Med. 2005;353(11):1124–34.Google Scholar
4Wei, G, Ji, X, Bai, H, Ding, Y.Stroke research in China. Neurol Res. 2006;28(1):11–15.Google Scholar
5Zhang, LF, Yang, J, Hong, Z, et al.Proportion of different subtypes of stroke in China. Stroke. 2003;34(9):2091–6.CrossRefGoogle ScholarPubMed
6Hajat, C, Dundas, R, Stewart, JA, et al.Cerebrovascular risk factors and stroke subtypes. Stroke. 2001;32(1):37–42.Google Scholar
7Prospective Studies Collaboration. Cholesterol, diastolic blood pressure, and stroke: 13000 strokes in 450,000 people in 45 prospective cohorts. Lancet. 1995;346(8991-2):1647–53.Google Scholar
8Eastern Stroke and Coronary Heart Disease Collaborative Research Group. Blood pressure, cholesterol, and stroke in eastern Asia. Lancet. 1998;352(9143):1801–7.CrossRefGoogle Scholar
9Whelton, PK, He, J.Blood pressure reduction. In: Manson, JE, Buring, JE, Ridker, PM, Gaziano, JM, editors. Clinical trials in cardiovascular disease, 2nd ed. Philadelphia: Elsevier Saunders; 1999. p. 282–96.Google Scholar
10Bath, P, Chalmers, J, Powers, W, et al.International Society of Hypertension Writing Group. International Society of Hypertension (ISH): statement on the management of blood pressure in acute stroke. J Hypertens. 2003;21(4):665–72.Google Scholar
11Chalmers, J.Blood pressure in acute stroke: in search of evidence. J Hypertens. 2005;23(2):277–8.Google Scholar
12Britton, M, Carlsson, A.Very high blood pressure in acute stroke. J Intern Med. 1990;228(6):611–5.Google Scholar
13Dandapani, BK, Suzuki, S, Kelley, RE, Reyes-Iglesias, Y, Duncan, RC.Relation between blood pressure and outcome in intracerebral haemorrhage. Stroke. 1995;26(1):21–4.CrossRefGoogle Scholar
14Robinson, TG, Dawson, SL, Ahmed, U, Manktelow, B, Fortherby, MD, Potter, JF.Twenty-four hour systolic blood pressure predicts long-term mortality following acute stroke. J Hypertens. 2001;19(12):2127–34.Google Scholar
15Ahmed, N, Wahlgren, N.High initial blood pressure after acute stroke is associated with poor functional outcome. J Intern Med. 2001;249(5):467–73.Google Scholar
16Leonardi-Bee, J, Bath, PM, Phillips, SJ, Sandercock, PA.Blood pressure and clinical outcomes in the International Stroke Trial. Stroke. 2002;33(5):1315–20.CrossRefGoogle ScholarPubMed
17Okumura, K, Ohya, Y, Maehara, A, Wakugami, K, Iseki, K, Takishita, S.Effects of blood pressure levels on case fatality after acute stroke. J Hypertens. 2005;23(6):1217–23.Google Scholar
18Vemmos, KN, Tsivgoulis, G, Spengos, K, et al.U-shaped relationship between mortality and admission blood pressure in patients with acute stroke. J Intern Med. 2004;255(2):257–65.CrossRefGoogle ScholarPubMed
19Castillo, J, Leira, R, Garcia, M, Serena, J, Blanco, M, Davalos, A.Blood pressure decrease during the acute phase of ischemic stroke is associated with brain injury stroke outcome. Stroke. 2004;35(2):520–6.Google Scholar
20Aslanyan, S, Fazekas, F, Weir, CJ, Horner, S, Lees, KR.Effect of blood pressure during the acute period of ischemic stroke on stroke outcome: atertiary analysis of the GAIN International Trial. Stroke. 2003;34(10):2420–5.Google Scholar
21Carlberg, B, Asplund, K, Hagg, E.The prognostic value of admission blood pressure in patients with acute stroke. Stroke. 1993;24(9):1372–5.Google Scholar
22Perloff, D, Grim, C, Flack, J, et al.Human blood pressure determination by sphygmomanometry. Circulation. 1993;88(5 Pt 1):2460–70.Google Scholar
23Allain, CC, Poon, LS, Chan, CS, Richmond, W, Fu, PC.Enzymatic determination of total serum cholesterol. Clin Chem. 1974;20(4):470–5.Google Scholar
24Friedewald, WT, Levy, RI, Fredrickson, DS.Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18(6):499–502.Google Scholar
25Willmot, M, Leonardi-Bee, J, Bath, PM.High blood pressure in acute stroke and subsequent outcome: a systematic review. Hypertension. 2004;43(1):18–24.Google Scholar
26Bath, P, Chalmers, J, Powers, W, et al.International Society of Hypertension Writing Group. International Society of Hypertension (ISH): statement on the management of blood pressure in acute stroke. J Hypertens. 2003;21(4):665–72.Google Scholar
27Eveson, DJ, Robinson, TG, Potter, JF.Lisinopril for the treatment of hypertension within the first 24 hours of acute ischemic stroke and follow-up. Am J Hypertens. 2007;20(3):270–7.Google Scholar
28Potter, JF, Robinson, TG, Ford, GA, et al.Controlling hypertension and hypotension immediately post-stroke (CHHIPS): a randomised, placebo-controlled, double-blind pilot trial. Lancet Neurol. 2009;8(1):48–56.CrossRefGoogle ScholarPubMed
29Dawson, SL, Blake, MJ, Panerai, RB, Potter, JF.Dynamic but not static cerebral autoregulation is impaired in acute ischaemic stroke. Cerebrovasc Dis. 2000;10(2):126–32.Google Scholar
30Robinson, TG, James, M, Youde, J, Panerai, R, Potter, J.Cardiac baroreceptor sensitivity is impaired after acute stroke. Stroke. 1997;28(9):1671–6.CrossRefGoogle ScholarPubMed
31Sare, GM, Gray, LJ, Bath, PM.Effect of antihypertensive agents on cerebral blood flow and flow velocity in acute ischaemic stroke: systematic review of controlled studies. J Hypertens. 2008;26(6):1058–64.Google Scholar