title: Hypertension is Associated With Increased Mortality in Children Hospitalized With Arterial Ischemic Stroke.
abstract: BACKGROUND
  Recently a single-center study suggested that hypertension after stroke in children was a risk factor for mortality. Our goal was to assess the association between hypertension and outcome after arterial ischemic stroke in children from a large national sample.
  
  
  METHODS
  Using the Healthcare Cost and Utilization Project Kids' Inpatient Database, children (1-18 years) with a primary diagnosis of ischemic stroke (International Classification of Diseases, Ninth Revision [ICD-9] codes 433-437.1) who also had a diagnosis of elevated blood pressure (ICD-9 code 796.2) or hypertension (ICD-9 codes 401 and 405) from 2003, 2006, and 2009 were identified. Clinical characteristics, discharge outcomes, and length of stay were assessed. Multivariable logistic regression was used to assess the relationship between hypertension and in-hospital mortality or discharge outcomes.
  
  
  RESULTS
  Of 2590 children admitted with arterial ischemic stroke, 156 (6%) also had a diagnosis of hypertension. Ten percent of children with hypertension also had renal failure. Among patients with arterial ischemic stroke, hypertension was associated with increased mortality (7.4% vs. 2.8%; P = 0.01) and increased length of stay (mean 11 ± 17 vs. 7 ± 12 days; P = 0.004) compared with those without hypertension. After adjusting for age, sex, intubation, presence of a fluid and electrolyte disorder, and renal failure, children with hypertension had an increased odds of in-hospital death (odds ratio 1.2, 95% confidence interval [1.1-3.3, P = 0.04]).
  
  
  CONCLUSIONS
  Hypertension was associated with an increased risk of in-hospital death for children presenting with arterial ischemic stroke. Further prospective study of blood pressure in children with stroke is needed.
authors.affiliation: Department of Neurology, Ochsner Neuroscience Institute, Ochsner Clinic Foundation, New Orleans, Louisiana; Zeenat Qureshi Stroke Institute, St Cloud, Minnesota. Electronic address: malikmuhammad.adil@gmail.com.
authors.forename: Malik M
authors.initials: MM
authors.lastname: Adil
authors.affiliation: Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut; Department of Neurology, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Beslow
authors.affiliation: Zeenat Qureshi Stroke Institute, St Cloud, Minnesota.
authors.forename: Adnan I
authors.initials: AI
authors.lastname: Qureshi
authors.affiliation: Zeenat Qureshi Stroke Institute, St Cloud, Minnesota.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Malik
authors.affiliation: Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Lori C
authors.initials: LC
authors.lastname: Jordan
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology / Q000401:mortality; D007223:Infant; D007511:Ischemia / Q000150:complications*; D008297:Male; D016017:Odds Ratio; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000401:mortality
keywords: hypertension; ischemic stroke; mortality; pediatric stroke