Pulse Blood Pressure Correlates with Late Outcome in Acute Ischemic Stroke without Significant Culprit Artery Stenosis

Abstract

Background: This study was conducted to test the hypothesis that elevated blood pressure at the early stage is associated with unfavorable outcome in acute ischemic stroke patients with stenosis of less than 50% of the culprit artery.

Methods: Patients with acute ischemic stroke onset within 48 hours and stenosis of less than 50% of the culprit artery from a prospective stroke registry were analyzed. A modified Rankin Scale score of 1 or lower at 3 months was defined as a favorable late outcome. Univariate and multivariate logistic regression analyses were used to analyze the association between hemodynamic parameters and outcome.

Results: One hundred thirty-six patients fulfilled the selection criteria. Patients with favorable outcome had lower pulse pressure at emergency department (ED) triage, lower systolic blood pressure (SBP) at 24 hours, lower pulse pressure at 24 hours, and lower heart rate (HR) at 24 hours. The univariate logistic regression analysis showed that history of stroke, elevated SBP at 24 hours, elevated HR at 24 hours, elevated pulse pressure at 24 hours, and higher National Institutes of Health Stroke Scale score at ED triage were associated with a less favorable late outcome. Two separate models of multivariate logistic regression analyses showed that pulse pressure at ED triage and pulse pressure at 24 hours, respectively, were significantly associated with less favorable outcome.

Conclusions: Elevated pulse pressure at the early stage is independently associated with unfavorable late outcome in acute ischemic stroke patients with culprit artery stenosis less than 50%.

Keywords: Acute ischemic stroke; blood pressure; cerebral arteries; outcome.