4C.04

Abstract

Objective: Elevated blood pressure (BP) is commonly observed during an acute stroke and is often higher in patients with a history of hypertension. Several studies have shown that elevated admission systolic BP during acute stroke is associated with unfavorable outcome. Management of hypertension has been improved in recent years leading to a higher rate of BP control. Our aim was to evaluate trends in admission BP levels in patients admitted with acute stroke and transient ischemic attack (TIA) over the past decade. Design and method: Data were based on the triennial 2-month period (February to March 2004, March to April 2007, April to May 2010) National Acute Stroke Israeli Registry. The study population comprised 6177 patients, aged above 18 years who were hospitalized with acute stroke or TIA and had data on BP levels on admission. Among those who were included in the study, 4382 had ischemic stroke, 1227 had TIA and 476 had intracerebral hemorrhage. We compared patients’ characteristics and temporal trends of admission BP and antihypertensive therapy before admission. Results: Admission systolic BP (SBP) decreased from161 ± 29 mm Hg in 2004 to 153 ± 28 mm Hg in 2010 (p < 0.001). This trend was observed in patients with hypertension (164 ± 29 to 156 ± 28) and in those without hypertension (148 ± 26 to 140 ± 21). Similar tredns were observed for patients with TIA. The use of three or more antihypertensive agents increased from 16.9% in 2004 to 20% in 2010 (p = 0.02). In patients with acute stroke, admission SBP was associated with stroke severity (p < 0.001). Rate of disability at discharge or in-hospital death decreased from 71.3% in 2004 to 64.8% in 2010 (p < .0001). Admission SBP was associated with in-hospital death or short-term disability with an adjusted OR, for 10 mmHg change in SBP, of 1.040 (95% CI; 1.011–1.071). Conclusions: Admission SBP in patients with acute stroke and TIA decreased over the years and may contribute to the improved outcome in these patients.