Blood pressure as an independent prognostic factor in acute ischemic stroke.
OBJECTIVE
Blood pressure is elevated in most patients during acute ischemic stroke, but the prognostic significance of this is unclear as the current data yield conflicting results.


METHODS
Admission blood pressure from the 1281 patients in the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) was analyzed for prognostic significance as well as the risk of hemorrhagic transformation. We also examined weighted-average blood pressure over seven days, and the impact of a 30% change in blood pressure in 24 hours. Patients with severe hypertension were excluded from the TOAST trial.


RESULTS
Increasing systolic blood pressure (SBP) on admission, but not diastolic (DBP) or mean arterial pressure (MAP) was predictive of poor outcome, but this effect was not significant after adjustment for other know prognostic factors. Increasing weighted-average SBP and MAP over seven days were predictive for poor outcome, but a 30% change in blood pressure over 24 hours was not.


CONCLUSIONS
Admission blood pressure is not an independent prognostic factor in acute ischemic stroke, but the weighted-average of SBP and MAP over seven days probably does have predictive value with higher values having a worse prognosis. A prospective trial of blood pressure control during acute stroke is needed.
Stroke Center, University of California, San Diego, CA 92103-8466, USA.
Matt B
MB
Jensen
Bongin
B
Yoo
William R
WR
Clarke
Patricia H
PH
Davis
Harold R
HR
Adams
D001794:Blood Pressure; D002545:Brain Ischemia / Q000503:physiopathology*; D006801:Humans; D006973:Hypertension / Q000150:complications; D007022:Hypotension / Q000150:complications; D011237:Predictive Value of Tests; D011379:Prognosis; D020521:Stroke / Q000503:physiopathology*