Effect of blood pressure during the acute period of ischemic stroke on stroke outcome: a tertiary analysis of the GAIN International Trial.
OBJECTIVE
The effects of blood pressure (BP) and its fluctuations during the acute phase on the clinical course of ischemic stroke are incompletely understood. We tested the hypotheses that baseline mean arterial BP [MAP=(2xdiastolic BP+systolic BP)/3], weighted average MAP, and an increase or decrease of >30% from baseline MAP are independently associated with stroke outcome.


METHODS
We studied the 1455 patients with ischemic stroke in the Glycine Antagonist (Gavestinel) in Neuroprotection (GAIN) International Trial. BP management was at the discretion of investigators and was measured at 0, 0.5, 4, 12, 12.25, 60, and 60.25 hours. Outcome was assessed by mortality, Barthel Index (dead or 0 to 55 versus 60 to 90 versus > or =95), National Institutes of Health Stroke Scale (NIHSS) score (dead or > or =2), and Rankin Scale (dead or > or =2). Cox proportional-hazards and stepwise logistic regression modeling corrected for demography, medical history, stroke severity, and clinical subtype.


RESULTS
Elevated weighted average MAP was associated with poor outcome assessed by mortality at 3 months (hazard ratio, 1.16; 1.06 to 1.27 per 10 mm Hg), NIHSS score (odds ratio [OR] 1.14; 95% confidence interval [CI], 1.01 to 1.28), and Barthel Index at 1 month (OR, 1.12; 95% CI, 1.03 to 1.23). A 30% increase from baseline MAP was associated with poor outcome assessed by NIHSS score and Barthel Index at 1 and 3 months and by Rankin score at 1 month (OR, 2.01; 95% CI, 1.16 to 3.49 to OR, 3.03; 95% CI, 1.30 to 7.02).


CONCLUSIONS
Baseline MAP was not associated with poor ischemic stroke outcome. However, variables describing the course of BP over the first 2.5 days have a marked and independent relationship with 1- and 3-month outcome.
D000208:Acute Disease; D000319:Adrenergic beta-Antagonists / Q000009:adverse effects; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D002543:Cerebral Hemorrhage / Q000209:etiology; D004176:Dipyridamole / Q000627:therapeutic use; D018450:Disease Progression; D004311:Double-Blind Method; D005260:Female; D018684:Glycine Agents / Q000627:therapeutic use; D006801:Humans; D007211:Indoles / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D016017:Odds Ratio; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D016896:Treatment Outcome
C105319:3-(2-((phenylamino)carbonyl)ethenyl)-4,6-dichloroindole-2-carboxylic acid; D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D018684:Glycine Agents; D007211:Indoles; D010726:Phosphodiesterase Inhibitors; D004176:Dipyridamole