title: The relationship between baseline blood pressure and computed tomography findings in acute stroke: data from the tinzaparin in acute ischaemic stroke trial (TAIST).
abstract: OBJECTIVE
  High blood pressure (BP) is present in approximately 80% of patients with acute ischemic stroke and is independently associated with poor outcome. There are few data examining the relationship between admission BP and acute CT findings.
  
  
  METHODS
  TAIST was a randomized controlled trial assessing 10 days of treatment with tinzaparin versus aspirin in 1489 patients with acute ischemic stroke (<48 hr) with admission BP of </=220/120 mmHg. CT brain scans were performed before randomization and after 10 days. The relationships between baseline BP and adjudicated CT findings were assessed. Odds ratios per 10 mmHg change in BP were calculated.
  
  
  RESULTS
  Higher systolic BP (SBP) was associated with abnormal CT scans because of independent associations with chronic changes of leukoariosis (OR, 1.12; 95% CI, 1.05-1.17) and old infarction (OR, 1.12; 95% CI, 1.06-1.17) at baseline, and signs of visible infarction at day 10 (OR, 1.06; 95% CI, 1.00-1.13). A lower SBP was associated with signs of acute infarction (OR, 0.94; 95% CI, 0.89-0.99). Hemorrhagic transformation, dense middle cerebral artery sign, mass effect, and cerebral edema at day 10 were not independently associated with baseline BP.
  
  
  CONCLUSIONS
  Although high baseline BP is independently associated with a poor outcome after stroke, this was not shown to be through an association with increased hemorrhagic transformation, cerebral edema, or mass effect; trial design may be suboptimal to detect this. Higher SBP is associated with visible infarction on day 10 scans. The influence of changing BP in acute stroke on CT findings is still to be ascertained.
authors.affiliation: Stroke Trials Unit, University of Nottingham, Clinical Sciences Building, City Hospital campus, Nottingham NG7 2UH UK.
authors.forename: Gillian M
authors.initials: GM
authors.lastname: Sare
authors.forename: Philip M W
authors.initials: PM
authors.lastname: Bath
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Gray
authors.forename: Thierry
authors.initials: T
authors.lastname: Moulin
authors.forename: France
authors.initials: F
authors.lastname: Woimant
authors.forename: Timothy
authors.initials: T
authors.lastname: England
authors.forename: Chamila
authors.initials: C
authors.lastname: Geeganage
authors.forename: Hanne
authors.initials: H
authors.lastname: Christensen
authors.forename: Peter Paul
authors.initials: PP
authors.lastname: De Deyn
authors.forename: Didier
authors.initials: D
authors.lastname: Leys
authors.forename: Desmond
authors.initials: D
authors.lastname: O'Neill
authors.forename: E Bernd
authors.initials: EB
authors.lastname: Ringelstein
mesh_terms: D000208:Acute Disease / Q000453:epidemiology; D001241:Aspirin / Q000008:administration & dosage; D001794:Blood Pressure / Q000502:physiology*; D001921:Brain / Q000098:blood supply / Q000473:pathology* / Q000503:physiopathology; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology*; D015984:Causality; D002543:Cerebral Hemorrhage / Q000453:epidemiology; D015897:Comorbidity; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D015994:Incidence; D049292:Leukoaraiosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology*; D000078222:Tinzaparin; D014057:Tomography, X-Ray Computed
chemical_list: D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D000078222:Tinzaparin; D001241:Aspirin