title: Initial blood pressure is associated with stroke severity and is predictive of admission cost and one-year outcome in different stroke subtypes: a SRICHS registry study.
abstract: BACKGROUND
  To investigate if initial blood pressure (BP) on admission is associated with stroke severity and predictive of admission costs and one-year-outcome in acute ischemic (IS) and hemorrhagic stroke (HS).
  
  
  METHODS
  This is a single-center retrospective cohort study. Stroke patients admitted within 3 days after onset between January 1st and December 31st in 2009 were recruited. The initial BP on admission was subdivided into high (systolic BP ≥ 211 mmHg or diastolic BP ≥ 111 mmHg), medium (systolic BP 111-210 mmHg or diastolic BP 71-110 mmHg), and low (systolic BP ≤ 110 mmHg or diastolic BP ≤ 70 mmHg) groups and further subgrouped with 25 mmHg difference in systole and 10 mmHg difference in diastole for the correlation analysis with demographics, admission cost and one-year modified Rankin scale (mRS).
  
  
  RESULTS
  In 1173 IS patients (mean age: 67.8 ± 12.8 years old, 61.4% male), low diastolic BP group had higher frequency of heart disease (p =0.001), dehydration (p =0.03) and lower hemoglobin level (p <0.001). The extremely high and low systolic BP subgroups had worse National Institutes of Health Stroke Scale (NIHSS) score (p =0.03), higher admission cost (p <0.001), and worse one-year mRS (p =0.03), while extremely high and low diastolic BP subgroups had higher admission cost (p <0.01). In 282 HS patients (mean age: 62.4 ± 15.4 years old, 60.6% male), both low systolic and diastolic BP groups had lower hemoglobin level (systole: p =0.05; diastole: p <0.001). The extremely high and low BP subgroups had worse NIHSS score (p =0.01 and p <0.001, respectively), worse one-year mRS (p =0.002 and p =0.001, respectively), and higher admission cost (diastole: p <0.002).
  
  
  CONCLUSIONS
  Stroke patients with extremely high and low BP on admission have not only worse stroke severity but also higher admission cost and/or worse one-year outcome. In those patients with low BP, low admission hemoglobin might be a contributing factor.
authors.affiliation: Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, 5 Fu-Hsing St., Kueishan, Taoyuan, 33333, Taiwan.|Graduate Institute of Clinical Medical Sciences, Division of Medical Education, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chi-Hung
authors.initials: CH
authors.lastname: Liu
authors.affiliation: Department of Neurology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.
authors.forename: Yi-Chia
authors.initials: YC
authors.lastname: Wei
authors.affiliation: Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Jr-Rung
authors.initials: JR
authors.lastname: Lin
authors.affiliation: Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, 5 Fu-Hsing St., Kueishan, Taoyuan, 33333, Taiwan.|Department of Electrical Engineering, College of Engineering, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chien-Hung
authors.initials: CH
authors.lastname: Chang
authors.affiliation: Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, 5 Fu-Hsing St., Kueishan, Taoyuan, 33333, Taiwan.
authors.forename: Ting-Yu
authors.initials: TY
authors.lastname: Chang
authors.affiliation: Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, 5 Fu-Hsing St., Kueishan, Taoyuan, 33333, Taiwan.
authors.forename: Kuo-Lun
authors.initials: KL
authors.lastname: Huang
authors.affiliation: Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, 5 Fu-Hsing St., Kueishan, Taoyuan, 33333, Taiwan.
authors.forename: Yeu-Jhy
authors.initials: YJ
authors.lastname: Chang
authors.affiliation: Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, 5 Fu-Hsing St., Kueishan, Taoyuan, 33333, Taiwan.
authors.forename: Shan-Jin
authors.initials: SJ
authors.lastname: Ryu
authors.affiliation: Department of Emergency Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.
authors.forename: Leng-Chieh
authors.initials: LC
authors.lastname: Lin
authors.affiliation: Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, 5 Fu-Hsing St., Kueishan, Taoyuan, 33333, Taiwan. thlee@adm.cgmh.org.tw.
authors.forename: Tsong-Hai
authors.initials: TH
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D002545:Brain Ischemia / Q000503:physiopathology*; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D020521:Stroke / Q000503:physiopathology*; D014481:United States