Relationship between hyperacute blood pressure and outcome after ischemic stroke: data from the VISTA collaboration.
OBJECTIVE
High blood pressure (BP) is associated independently with poor outcome after acute ischemic stroke, although in most analyses "baseline" BP was measured 24 hours or more postictus, and not during the hyperacute period.


METHODS
Analyses included 1722 patients in hyperacute trials (recruitment <8 hours) from the Virtual Stroke International Stroke Trial Archive (VISTA) Collaboration. Data on BP at enrollment and after 1, 2, 16, 24, 48, and 72 hours, neurological impairment at 7 days (NIHSS), and functional outcome at 90 days (modified Rankin scale) were assessed using logistic regression models, adjusted for confounding variables; results are for 10-mm Hg change in BP.


RESULTS
Mean time to enrollment was 3.7 hours (range 1.0 to 7.9). High systolic BP (SBP) was significantly associated with increased neurological impairment (odds ratio, OR 1.06, 95% confidence interval, 95% CI 1.01 to 1.12), and poor functional outcome; odds ratios for both increased with later BP measurements made at up to 24 hours poststroke. Smaller (versus larger) declines in SBP over the first 24 hours were significantly associated with poor NIHSS scores (OR 1.16, 95% CI 1.05 to 1.27) and functional outcome (OR 1.23, 95% CI 1.13 to 1.34). A large variability in SBP was also associated with poor functional outcome.


CONCLUSIONS
High SBP and large variability in SBP in the hyperacute stages of ischemic stroke are associated with increased neurological impairment and poor functional outcome, as are small falls in SBP over the first 24 hours.
Stroke Trials Unit, University of Nottingham, Clinical Sciences Building, City Hospital Campus, Nottingham NG5 1PB UK.
Gillian M
GM
Sare
Myzoon
M
Ali
Ashfaq
A
Shuaib
Philip M W
PM
Bath
D000208:Acute Disease; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology*; D002545:Brain Ischemia / Q000150:complications* / Q000503:physiopathology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D016015:Logistic Models; D008297:Male; D009422:Nervous System Diseases / Q000453:epidemiology / Q000209:etiology; D016017:Odds Ratio; D020521:Stroke / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome
D000959:Antihypertensive Agents