Abstract 115: Blood Pressure Trajectories In The Acute Phase And Major Clinical Outcomes Among Patients With Ischemic Stroke

Abstract

We studied the relationship of blood pressure (BP) trajectories during the first seven days after symptom onset with short- and long-term major clinical outcomes among patients with acute ischemic stroke. A total of 4,036 patients with acute ischemic stroke and elevated systolic BP from the CATIS trial were included in this analysis. Three BPs were measured every 2 hours for the first 24 hours, every 4 hours during the second and third days, and every 8 hours thereafter for the remainder of the seven days. Latent class models were used to identify subgroups that share a similar underlying trajectory in BP in the acute phase. Five systolic BP trajectories of high, high-to-moderate low, moderate high, moderate low, and low were identified. Compared to the high trajectory, multiple-adjusted odds ratios (95% CI) of death and major disability at 3 months for high-to-moderate low, moderate high, moderate low, and low trajectories were 0.61 (0.44 to 0.86), 0.63 (0.48 to 0.84), 0.49 (0.37 to 0.65), and 0.42 (0.30 to 0.59), respectively (overall p<0.0001). Likewise, the corresponding multiple-adjusted odds ratios at 2 years were 0.64 (0.46 to 0.90), 0.78 (0.59 to 1.04), 0.49 (0.37 to 0.66), and 0.49 (0.34 to 0.69), respectively (overall p<0.0001). These data indicate that individuals with a consistently high systolic BP during the acute phase of ischemic stroke had the highest risk of short- and long-term death and major disability. In addition, moderate systolic BP reduction to below 140 mmHg from higher levels lowers risk of short- and long-term death and major disability.