title: Systolic blood pressure during acute stroke is associated with functional status and long-term mortality in the elderly.
abstract: OBJECTIVE
  The prognostic value of blood pressure (BP) levels during acute stroke has not been adequately studied. Most studies do not use continuous BP measurements, and patients are followed only for a short period. We designed a study to assess, with 24-hour BP monitoring (24H BPM), the impact of BP levels during the first day of stroke, on the short-term functional status and long-term mortality in elderly patients.
  
  
  METHODS
  We studied 177 patients with acute stroke (89 men), mean age 84±6 years. BP was measured on admission and 24H BPM was recorded within 24 hours of admission. After 7 days, patients were assessed for functional status according to the modified Rankin Scale and were subsequently followed up for mortality ≤5 years (mean, 2.07±1.48).
  
  
  RESULTS
  After 7 days, functional status improved and modified Rankin Scale decreased from 4.2 to 3.7. Follow-up analysis disclosed that 71 patients (27 men and 44 women) had died. Mortality rate was higher in women (50% versus 30%; P<0.01) and in patients with a history of congestive heart failure. Only average systolic BP, recorded by 24H BPM, predicted short-term functional status and long-term mortality. Cox proportional hazards model analysis demonstrated that age, sex, congestive heart failure, and average systolic BP >160 mm Hg, recorded by 24H BPM, were associated with increased mortality.
  
  
  CONCLUSIONS
  High systolic BP recorded by 24H BPM on the first day of stroke was found to be associated with unfavorable short-term functional status and long-term mortality in elderly patients.
authors.affiliation: Rabin Medical Center, Petach Tikvah, Israel.
authors.forename: Avraham
authors.initials: A
authors.lastname: Weiss
authors.forename: Yichayaou
authors.initials: Y
authors.lastname: Beloosesky
authors.forename: Ron S
authors.initials: RS
authors.lastname: Kenett
authors.forename: Ehud
authors.initials: E
authors.lastname: Grossman
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology*; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D008134:Long-Term Care; D008297:Male; D012720:Severity of Illness Index; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology / Q000401:mortality* / Q000503:physiopathology*
keywords: acute stroke; ambulatory blood pressure monitoring; elderly; mortality