title: Blood pressure changes in acute ischemic stroke and outcome with respect to stroke etiology.
abstract: OBJECTIVE
  Previous research suggested that proper blood pressure (BP) management in acute stroke may need to take into account the underlying etiology.
  
  
  METHODS
  All patients with acute ischemic stroke registered in the ASTRAL registry between 2003 and 2009 were analyzed. Unfavorable outcome was defined as modified Rankin Scale score >2. A local polynomial surface algorithm was used to assess the effect of baseline and 24- to 48-hour systolic BP (SBP) and mean arterial pressure (MAP) on outcome in patients with lacunar, atherosclerotic, and cardioembolic stroke.
  
  
  RESULTS
  A total of 791 patients were included in the analysis. For lacunar and atherosclerotic strokes, there was no difference in the predicted probability of unfavorable outcome between patients with an admission BP of <140 mm Hg, 140-160 mm Hg, or >160 mm Hg (15.3 vs 12.1% vs 20.8%, respectively, for lacunar, p = 015; 41.0% vs 41.5% vs 45.5%, respectively, for atherosclerotic, p = 075), or between patients with BP increase vs decrease at 24-48 hours (18.7% vs 18.0%, respectively, for lacunar, p = 0.84; 43.4% vs 43.6%, respectively, for atherosclerotic, p = 0.88). For cardioembolic strokes, increase of BP at 24-48 hours was associated with higher probability of unfavorable outcome compared to BP reduction (53.4% vs 42.2%, respectively, p = 0.037). Also, the predicted probability of unfavorable outcome was significantly different between patients with an admission BP of <140 mm Hg, 140-160 mm Hg, and >160 mm Hg (34.8% vs 42.3% vs 52.4%, respectively, p < 0.01).
  
  
  CONCLUSIONS
  This study provides evidence to support that BP management in acute stroke may have to be tailored with respect to the underlying etiopathogenetic mechanism.
authors.affiliation: Department of Medicine, University of Thessaly, Larissa, Greece. gntaios@med.uth.gr
authors.forename: G
authors.initials: G
authors.lastname: Ntaios
authors.forename: D
authors.initials: D
authors.lastname: Lambrou
authors.forename: P
authors.initials: P
authors.lastname: Michel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D062186:Arterial Pressure; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination; D002545:Brain Ischemia / Q000150:complications* / Q000209:etiology; D002340:Carotid Artery Diseases / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011336:Probability; D012042:Registries; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis / Q000209:etiology*; D059409:Stroke, Lacunar / Q000150:complications; D013997:Time Factors