title: Blood pressure in acute ischemic stroke and mortality: a study with noninvasive blood pressure monitoring.
abstract: BACKGROUND
  In acute ischemic stroke, a transient elevation of blood pressure is common; its significance and its relationship with the neurological outcome are still unclear.
  
  
  METHODS
  In 71 consecutive patients with acute ischemic stroke, aged 25-94 years, admitted to our unit, we investigated the relationships between the blood pressure variation during the first 24 h and mortality at 3 months (study endpoint). Neurological status was assessed with the National Institutes of Health Stroke Scale. Blood pressure was measured with bedside noninvasive blood pressure monitoring every 15 min. The mean of four measurements at the emergency department and the mean of 12 measures (during a 3-h interval) at 12 and at 24 h after stroke onset were considered for analysis. Antihypertensive treatment was given in accordance with the Recommendations for Stroke Management of European Stroke Initiative.
  
  
  RESULTS
  In the whole series, 21% were atherothrombotic, 32% cardioembolic, 34% lacunar, and 13% of unknown or other cause. Blood pressure was 160+ or -3/86+ or -2 mmHg at the emergency department, 148+ or -3/82+ or -2 mmHg at 12 h, and 147+ or -3/81+ or -2 mmHg at 24 h (P<0.05). Four patients (11%) of those in whom mean blood pressure decreased >5 mmHg, and 12 (33%) of the others, in whom mean blood pressure decreased < or =5 mmHg or did not decrease, reached the endpoint (P<0.05). According to the multivariate Cox model, NIHSS score at the emergency department (95% confidence interval: 1.025-1.238, P=0.013) and age (95% confidence interval: 1.007-1.259, P=0.038) were predictors of reaching the endpoint, whereas mean blood pressure reduction 24 h after stroke onset had a protective effect (95% confidence interval: 0.845-0.995, P=0.038). Diabetes, mean blood pressure at the emergency department and the need for antihypertensive therapy did not correlate with the outcome.
  
  
  CONCLUSIONS
  Noninvasive blood pressure monitoring during the first 24 h of acute ischemic stroke may be useful in the prognostic stratification by showing moderate blood pressure decrease, either spontaneous or drug induced, which is associated with a favorable prognosis at 3 months.
authors.affiliation: Clinica Medica 4, Department of Clinical and Experimental Medicine, University of Padova, Padova, Italy.
authors.forename: Michelangelo
authors.initials: M
authors.lastname: Sartori
authors.forename: Valentina
authors.initials: V
authors.lastname: Benetton
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Carraro
authors.forename: Lorenzo A
authors.initials: LA
authors.lastname: Calò
authors.forename: Luisa
authors.initials: L
authors.lastname: Macchini
authors.forename: Valter
authors.initials: V
authors.lastname: Giantin
authors.forename: Franco
authors.initials: F
authors.lastname: Tosato
authors.forename: Achille C
authors.initials: AC
authors.lastname: Pessina
authors.forename: Andrea
authors.initials: A
authors.lastname: Semplicini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D001795:Blood Pressure Determination; D002545:Brain Ischemia / Q000401:mortality / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D020521:Stroke / Q000401:mortality / Q000503:physiopathology*; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents