title: The impact of blood pressure hemodynamics in acute ischemic stroke: a prospective cohort study.
abstract: OBJECTIVE
  To assess relationships between blood pressure hemodynamic measures and outcomes after acute ischemic stroke, including stroke severity, disability and death.
  
  
  METHODS
  The study cohort consisted of 189 patients who presented to our emergency department with ischemic stroke of less than 24 hours onset who had hemodynamic parameters recorded and available for review. Blood pressure (BP) was non-invasively measured at 5 minute intervals for the length of the patient's emergency department stay. Systolic BP (sBP) and diastolic BP (dBP) were measured for each patient and a differential (the maximum minus the minimum BP) calculated. Three outcomes were studied: stroke severity, disability at hospital discharge, and death at 90 days. Statistical tests used included Spearman correlations (for stroke severity), Wilcoxon test (for disability) and Cox models (for death).
  
  
  RESULTS
  Larger differentials of either dBP (p = 0.003) or sBP (p < 0.001) were significantly associated with more severe strokes. A greater dBP (p = 0.019) or sBP (p = 0.036) differential was associated with a significantly worse functional outcome at hospital discharge. Those patients with larger differentials of either dBP (p = 0.008) or sBP (0.007) were also significantly more likely to be dead at 90 days, independently of the basal BP.
  
  
  CONCLUSIONS
  A large differential in either systolic or diastolic blood pressure within 24 hours of symptom onset in acute ischemic stroke appears to be associated with more severe strokes, worse functional outcome and early death.
authors.affiliation: Department of Emergency Medicine, Mayo Medical School, Rochester, MN, USA. lstead@ufl.edu.
authors.forename: Latha Ganti
authors.initials: LG
authors.lastname: Stead
authors.forename: Sailaja
authors.initials: S
authors.lastname: Enduri
authors.forename: M Fernanda
authors.initials: MF
authors.lastname: Bellolio
authors.forename: Anunaya R
authors.initials: AR
authors.lastname: Jain
authors.forename: Lekshmi
authors.initials: L
authors.lastname: Vaidyanathan
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Gilmore
authors.forename: Rahul
authors.initials: R
authors.lastname: Kashyap
authors.forename: Amy L
authors.initials: AL
authors.lastname: Weaver
authors.forename: Robert D
authors.initials: RD
authors.lastname: Brown