Blood pressure course in acute ischaemic stroke in relation to stroke subtype.
OBJECTIVE
Blood pressure (BP) management in acute stroke remains a matter of little consensus. Data on BP changes during the first hours of ictus are lacking. We aimed to evaluate the early spontaneous time course of BP in different ischaemic stroke (IS) subtypes.


METHODS
Twenty-four h BP monitoring was performed in 200 first-ever hyper-acute IS patients. The recording was initiated and terminated at 3 h and 27 h of ictus respectively. All IS patients were classified on admission into the following subgroups of different etiology: large artery atherosclerotic stroke (LAA), cardio-embolic stroke (CE), lacunar stroke (LAC) and infarct of undetermined cause (IUC). Statistical comparisons between stroke subgroups were performed using one-way ANOVA and linear regression analyses were used to evaluate the influence of different factors in BP course.


RESULTS
Although there were no significant differences in 24 h systolic (SBP) and diastolic (DBP) BP values between IS subgroups, a distinctly different SBP course was observed. The SBP dropped sharply in the LAA and LAC subgroups, while a more gradual decrease was monitored in the CE subgroup. Throughout the BP-recording, a SBP decrease of 10.1% (95% CI: 8.6-11.5) and 10.4% (95% CI: 9.0-11.8) was documented in patients with LAA and LAC respectively, while a milder drop was recorded in CE (3.7%, 95% CI: 2.4-5.0) and IUC (5.5%, 95% CI: 4.1-6.8). Increasing stroke severity (p<0.001) and brain oedema (p=0.013) was independently associated with a milder spontaneous SBP reduction.


CONCLUSIONS
Spontaneous SBP course varies in acute ischaemic stroke subtypes of different etiology. This may have implications in the optimal management of post-stroke hypertension.
Vemmos
Konstantinos N
KN
Department of Clinical Therapeutics, Acute Stroke Unit, University of Athens Medical School, Alexandra Hospital, Athens, Greece. vemmosk@ath.forthnet.gr
Tsivgoulis
Georgios
G
Spengos
Konstantinos
K
Synetos
Andreas
A
Manios
Efstathios
E
Vassilopoulou
Sofia
S
Zis
Vassilios
V
Zakopoulos
Nikolaos
N
D000208:Acute Disease; D000368:Aged; D000704:Analysis of Variance; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D020520:Brain Infarction / Q000503:physiopathology; D002545:Brain Ischemia / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000503:physiopathology; D020766:Intracranial Embolism / Q000503:physiopathology; D008875:Middle Aged; D020521:Stroke / Q000209:etiology / Q000503:physiopathology*; D013995:Time