title: Acute-Phase Blood Pressure Levels Correlate With a High Risk of Recurrent Strokes in Young-Onset Ischemic Stroke.
abstract: High blood pressure (BP) in acute stroke has been associated with a poor outcome; however, this has not been evaluated in young adults.
  
  
  
  The relationship between BP and long-term outcome was assessed in 1004 consecutive young, first-ever ischemic stroke patients aged 15 to 49 years enrolled in the Helsinki Young Stroke Registry. BP parameters included systolic (SBP) and diastolic BP, pulse pressure, and mean arterial pressure at admission and 24 hours. The primary outcome measure was recurrent stroke in the long-term follow-up. Adjusted for demographics and preexisting comorbidities, Cox regression models were used to assess independent BP parameters associated with outcome.
  
  
  
  Of our patients (63% male), 393 patients (39%) had prestroke hypertension and 358 (36%) used antihypertensive treatment. The median follow-up period was 8.9 years (interquartile range 5.7-13.2). Patients with a recurrent stroke (n=142, 14%) had significantly higher admission SBP, diastolic BP, pulse pressure, and mean arterial pressure (P<0.001) and 24-h SBP, diastolic BP, and mean arterial pressure compared with patients without the recurrent stroke. Patients with SBP ≥160 mm Hg compared with those with SBP <160 mm Hg had significantly more recurrent strokes (hazard ratio 3.3 [95% confidence interval, 2.05-4.55]; P<0.001) occurring earlier (13.9 years [13.0-14.6] versus 16.2 [15.8-16.6]; P<0.001) within the follow-up period. In multivariable analyses, higher admission SBP, diastolic BP, pulse pressure, and mean arterial pressure were independently associated with the risk of recurrent stroke, while the 24-hour BP levels were not.
  
  
  
  In young ischemic stroke patients, high acute phase BP levels are independently associated with a high risk of recurrent strokes.
authors.affiliation: From the Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland (S.M., J. Putaala, L.T., K.A., J. Pirinen, T.T.); Abdominal Center Nephrology, Helsinki University Hospital, Folkhälsan Institute of Genetics at Folkhälsan Research Center, and Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland (D.G.); Department of Clinical Physiology and Nuclear Medicine, HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland (J. Pirinen, I.S.); Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland (J. Pirinen, J.S., M.L.); and Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.). satu.mustanoja@hus.fi.
authors.forename: Satu
authors.initials: S
authors.lastname: Mustanoja
authors.affiliation: From the Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland (S.M., J. Putaala, L.T., K.A., J. Pirinen, T.T.); Abdominal Center Nephrology, Helsinki University Hospital, Folkhälsan Institute of Genetics at Folkhälsan Research Center, and Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland (D.G.); Department of Clinical Physiology and Nuclear Medicine, HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland (J. Pirinen, I.S.); Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland (J. Pirinen, J.S., M.L.); and Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.).
authors.forename: Jukka
authors.initials: J
authors.lastname: Putaala
authors.affiliation: From the Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland (S.M., J. Putaala, L.T., K.A., J. Pirinen, T.T.); Abdominal Center Nephrology, Helsinki University Hospital, Folkhälsan Institute of Genetics at Folkhälsan Research Center, and Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland (D.G.); Department of Clinical Physiology and Nuclear Medicine, HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland (J. Pirinen, I.S.); Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland (J. Pirinen, J.S., M.L.); and Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.).
authors.forename: Daniel
authors.initials: D
authors.lastname: Gordin
authors.affiliation: From the Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland (S.M., J. Putaala, L.T., K.A., J. Pirinen, T.T.); Abdominal Center Nephrology, Helsinki University Hospital, Folkhälsan Institute of Genetics at Folkhälsan Research Center, and Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland (D.G.); Department of Clinical Physiology and Nuclear Medicine, HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland (J. Pirinen, I.S.); Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland (J. Pirinen, J.S., M.L.); and Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.).
authors.forename: Lauri
authors.initials: L
authors.lastname: Tulkki
authors.affiliation: From the Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland (S.M., J. Putaala, L.T., K.A., J. Pirinen, T.T.); Abdominal Center Nephrology, Helsinki University Hospital, Folkhälsan Institute of Genetics at Folkhälsan Research Center, and Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland (D.G.); Department of Clinical Physiology and Nuclear Medicine, HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland (J. Pirinen, I.S.); Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland (J. Pirinen, J.S., M.L.); and Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.).
authors.forename: Karoliina
authors.initials: K
authors.lastname: Aarnio
authors.affiliation: From the Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland (S.M., J. Putaala, L.T., K.A., J. Pirinen, T.T.); Abdominal Center Nephrology, Helsinki University Hospital, Folkhälsan Institute of Genetics at Folkhälsan Research Center, and Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland (D.G.); Department of Clinical Physiology and Nuclear Medicine, HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland (J. Pirinen, I.S.); Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland (J. Pirinen, J.S., M.L.); and Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.).
authors.forename: Jani
authors.initials: J
authors.lastname: Pirinen
authors.affiliation: From the Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland (S.M., J. Putaala, L.T., K.A., J. Pirinen, T.T.); Abdominal Center Nephrology, Helsinki University Hospital, Folkhälsan Institute of Genetics at Folkhälsan Research Center, and Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland (D.G.); Department of Clinical Physiology and Nuclear Medicine, HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland (J. Pirinen, I.S.); Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland (J. Pirinen, J.S., M.L.); and Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.).
authors.forename: Ida
authors.initials: I
authors.lastname: Surakka
authors.affiliation: From the Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland (S.M., J. Putaala, L.T., K.A., J. Pirinen, T.T.); Abdominal Center Nephrology, Helsinki University Hospital, Folkhälsan Institute of Genetics at Folkhälsan Research Center, and Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland (D.G.); Department of Clinical Physiology and Nuclear Medicine, HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland (J. Pirinen, I.S.); Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland (J. Pirinen, J.S., M.L.); and Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.).
authors.forename: Juha
authors.initials: J
authors.lastname: Sinisalo
authors.affiliation: From the Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland (S.M., J. Putaala, L.T., K.A., J. Pirinen, T.T.); Abdominal Center Nephrology, Helsinki University Hospital, Folkhälsan Institute of Genetics at Folkhälsan Research Center, and Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland (D.G.); Department of Clinical Physiology and Nuclear Medicine, HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland (J. Pirinen, I.S.); Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland (J. Pirinen, J.S., M.L.); and Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.).
authors.forename: Mika
authors.initials: M
authors.lastname: Lehto
authors.affiliation: From the Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland (S.M., J. Putaala, L.T., K.A., J. Pirinen, T.T.); Abdominal Center Nephrology, Helsinki University Hospital, Folkhälsan Institute of Genetics at Folkhälsan Research Center, and Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland (D.G.); Department of Clinical Physiology and Nuclear Medicine, HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland (J. Pirinen, I.S.); Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland (J. Pirinen, J.S., M.L.); and Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.).
authors.forename: Turgut
authors.initials: T
authors.lastname: Tatlisumak
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D001794:Blood Pressure / Q000502:physiology*; D002545:Brain Ischemia / Q000503:physiopathology* / Q000628:therapy; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D012008:Recurrence; D012042:Registries / Q000706:statistics & numerical data*; D020521:Stroke / Q000503:physiopathology* / Q000628:therapy; D055815:Young Adult
keywords: blood pressure; hypertension; prognosis; stroke; stroke in the young