New-onset hypertension and inflammatory response/poor outcome in acute ischemic stroke.
OBJECTIVE
To study the association of previously unknown high blood pressure (HBP) during the acute phase of stroke (new-onset hypertension) with the inflammatory response and clinical outcome.


METHODS
We classified 844 patients with hemispheric ischemic stroke into three groups according to history of hypertension and presence of HBP within the first 24 hours after symptom onset: Group I (n = 412), normotensive patients; Group II (n = 265), chronic hypertensive patients; and Group III (n = 167), new-onset hypertensive patients. Interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-alpha), intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1), and metalloproteinase 9 (MMP-9) were measured in blood samples obtained on admission. The influence of new-onset HBP and markers of inflammation on poor neurologic outcome at 3 months was evaluated by logistic regression analysis.


RESULTS
New-onset HBP was found in 19.9% of patients. Patients in this group had higher plasma concentrations of IL-6, TNF-alpha, ICAM-1, VCAM-1, and MMP-9 than the other two groups. New-onset HBP was associated with poor outcome at 3 months (odds ratio [OR] 2.10; 95% CI 1.54 to 3.52; p < 0.0001) after adjustment for other prognostic factors. However, when markers of inflammation were included in the model, IL-6 (OR 1.01; 95% CI 1.00 to 1.03; p = 0.020) and MMP-9 (OR 1.01; 95% CI 1.00 to 1.01; p < 0.0001), but not new-onset HBP, were independently associated with poor neurologic outcome.


CONCLUSIONS
New-onset high blood pressure in acute ischemic stroke, but not chronic hypertension, is associated with an inflammatory response and poor neurologic outcome.
Rodríguez-Yáñez
M
M
Department of Neurology, Stroke Unit, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain.
Castellanos
M
M
Blanco
M
M
García
M M
MM
Nombela
F
F
Serena
J
J
Leira
R
R
Lizasoain
I
I
Dávalos
A
A
Castillo
J
J
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000502:physiology; D002545:Brain Ischemia / Q000097:blood* / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000097:blood* / Q000453:epidemiology / Q000473:pathology; D018836:Inflammation Mediators / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D020521:Stroke / Q000097:blood / Q000453:epidemiology / Q000473:pathology*; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D018836:Inflammation Mediators