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Multicenter Study
. 2017 Oct 1;38(37):2827-2835.
doi: 10.1093/eurheartj/ehx330.

Blood pressure and in-hospital outcomes in patients presenting with ischaemic stroke

Sripal Bangalore  1 , Lee Schwamm  2 , Eric E Smith  3 , Anne S Hellkamp  4 , Robert E Suter  5 , Ying Xian  6 , Phillip J Schulte  4 , Gregg C Fonarow  7 , Deepak L Bhatt  8 ; Get With the Guidelines-Stroke Steering Committee and Investigators
Affiliations
Multicenter Study

Blood pressure and in-hospital outcomes in patients presenting with ischaemic stroke

Sripal Bangalore et al. Eur Heart J. .

Abstract

Aims: Post-stroke hypertension is associated with poor short-term outcome, although the results have been conflicting. Our objective was to evaluate the association of blood pressure (BP) and in-hospital outcomes in patients with acute ischaemic stroke.

Methods and results: Patients in the Get With The Guidelines-Stroke registry with acute ischaemic stroke were included. Admission systolic and diastolic BP was used to compute mean arterial pressure (MAP) and pulse pressure (PP). The outcomes of interest were: in-hospital mortality, not discharged home, inability to ambulate independently at discharge and haemorrhagic complications due to thrombolytic therapy. A total of 309 611 patients with an ischaemic stroke were included. There was a J-shaped/U-shaped relationship between systolic BP and outcomes. Both lower and higher systolic BP values, compared with a central reference value, had higher risk of in-hospital death [e.g. adjusted odds ratio (95% confidence interval) (OR[CI]) = 1.16[1.13-1.20] for 120 vs. 150 mmHg and 1.24[1.19-1.30] for 200 vs. 150 mmHg], not discharged home (OR[CI] = 1.11[1.09-1.13] for 120 vs. 150 mmHg and 1.15[1.12-1.18] for 200 vs. 150 mmHg), inability to ambulate independently at discharge (OR[CI] = 1.16[1.13-1.18] for 120 vs. 150 mmHg and 1.09[1.06-1.11] for 200 vs. 150 mmHg). However, risk of haemorrhagic complications of thrombolytic therapy was lower with lower systolic BP (OR[CI] = 0.89[0.83-0.97] for 120 vs. 150 mmHg), while higher with higher systolic BP (OR[CI] = 1.21[1.11-1.32] for 200 vs. 150 mmHg). The results were largely similar for admission diastolic BP, MAP, and PP.

Conclusion: In patients hospitalized with ischaemic stroke, J-shaped, or U-shaped relationships were observed between BP variables and short-term outcomes. However, haemorrhagic complications with thrombolytic therapy were lower with lower BP.

Keywords: Blood pressure; Diastolic; Ischaemic stroke; Mean arterial pressure; Pulse pressure; Stroke; Systolic; Transient ischaemic attack.

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Figures

Figure 1
Figure 1
Relationship between systolic blood pressure and outcomes in patients presenting with an ischaemic stroke. Adjusted odds ratio (OR) and 95% confidence interval (CI) are shown for each 10 mmHg change away from the reference value (150 mmHg).
Figure 2
Figure 2
Relationship between diastolic blood pressure and outcomes in patients presenting with an ischaemic stroke. Adjusted odds ratio (OR) and 95% confidence interval (CI) are shown for each 10 mmHg change away from the reference value (70 mmHg).
Figure 3
Figure 3
Interaction of thrombolytic use on the relationship between systolic blood pressure and outcomes in patients presenting with an ischaemic stroke.
Central Figure
Central Figure
Relationship between various blood pressure indices and in-hospital death in patients presenting with an ischaemic stroke. Adjusted odds ratio (OR) and 95% confidence interval (CI) are shown for each 10 mmHg change away from the reference value (150 mmHg).
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