Association between course of blood pressure within the first 24 hours and functional recovery after acute ischemic stroke.
OBJECTIVE
The relation between course of blood pressure within the first 24 hours after acute stroke and early neurologic outcome remains a matter of dispute. We investigate this relation with adjustment for other influencing variables.


METHODS
Three hundred seventy-two patients with the diagnosis of ischemic stroke were included to evaluate the relation between blood pressure course and early neurologic outcome. The following data were collected: age; sex; history of hypertension, diabetes mellitus, hyperlipidemia, coronary heart disease, peripheral vascular disease, and stroke; smoking habits; preadmission blood pressure, blood pressure on admission, and blood pressure 24 hours later; antihypertensive treatment; and stroke localization. We assessed outcome at day 5 after admission as dependent or independent (Rankin Scale score <or=2) and applied multivariate logistic regression analysis to investigate the effect of blood pressure changes on outcome, with adjustment for other baseline variables.


RESULTS
Relative changes of systolic and diastolic blood pressure within hospital admission to 24 hours after admission revealed significant differences of patients' neurologic outcome only for diastolic blood pressure changes from admission to 24 hours. A diastolic blood pressure decrease more than 25% from admission until 24 hours after admission was associated with a 3.8-fold increased adjusted odds (95% confidence interval 1.2 to 12.1) for poor neurologic outcome on day 5 (Rankin Scale score 3 to 5).


CONCLUSIONS
Excessive diastolic blood pressure reduction was associated with an increased risk for an impaired neurologic outcome in patients with ischemic stroke. The association between both characteristics was independent from concomitant risk factors, stroke localization, and possible antihypertensive treatment.
Department of Emergency Medicine, General Hospital, University of Vienna, Vienna, Austria.
Marianne
M
Vlcek
Martin
M
Schillinger
Wilfried
W
Lang
Wolfgang
W
Lalouschek
Andreas
A
Bur
Michael M
MM
Hirschl
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D002545:Brain Ischemia / Q000150:complications* / Q000534:rehabilitation; D003971:Diastole; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016037:Single-Blind Method; D020521:Stroke / Q000150:complications*; D000071939:Stroke Rehabilitation; D013599:Systole; D013997:Time Factors; D016896:Treatment Outcome
D000959:Antihypertensive Agents