Abstract

Background. The association between outcome and elevated admission blood pressure (BP) remains uncertain in acute stroke patients. The aim of the present study was to examine the association between admission blood pressure and outcome in ischemic stroke patients treated with tissue plasminogen activator (tPA). Method. This study included patients treated with tPA within 4.5 hours after symptom onset. Four quartiles based on the admission BP values were defined. BP development of the first 12 hours was compared to outcome parameters defined as NIHSS 24 hours after tPA and mRS after 3 months. Results. 265 patients were included. A trend with worse short- and long-term outcome was present in the quartiles with the lowest and highest admission BP compared to the quartile with admission values at 140–160 mm Hg systolic. BP in quartile 1 was insignificantly decreased after 12 hours while the BP in quartiles 3 and 4 remained above recommended levels. Conclusion. Admission BP is associated with short- and long-term outcome after stroke. Low- or high-admission BP indicates cardiac comorbidity or preexisting hypertension, where close monitoring and further examinations are requested to prevent poorer outcome.

Highlights

  • The relation between acutely elevated blood pressure and stroke severity and outcome in acute stroke fuels the continued debate whether the increase in blood pressure shall be seen primarily as a pathological mechanism or a physiological stress indicator.A U-shaped relation between the level of acute elevation in blood pressure and outcome has been introduced defining a middle area with better prognosis than patients with high as well as low blood pressure [1,2,3]

  • Patients with no premorbidity are considered to be able to develop a relevant stress response when afflicted with an acute vascular episode and in this group blood pressure levels decrease to normal levels within hours [8]

  • Identification of which subgroups of stroke patients could profit from blood pressure reduction or extensive cardiac work up is being investigated in ongoing studies and can be offered alongside standard acute treatment, that is, tissue plasminogen activator [12]

Read more

Summary

Introduction

The relation between acutely elevated blood pressure and stroke severity and outcome in acute stroke fuels the continued debate whether the increase in blood pressure shall be seen primarily as a pathological mechanism or a physiological stress indicator.A U-shaped relation between the level of acute elevation in blood pressure and outcome has been introduced defining a middle area with better prognosis than patients with high as well as low blood pressure [1,2,3]. In patient groups with preexisting hypertension a multifactorial genesis based on a combination of various risk factors and premorbid conditions results in a lack of blood pressure regulation. These patients have a further overshooting of the initial blood pressure levels which remain high throughout hospitalization and have a tendency towards a worse outcome [11]. The association between outcome and elevated admission blood pressure (BP) remains uncertain in acute stroke patients. The aim of the present study was to examine the association between admission blood pressure and outcome in ischemic stroke patients treated with tissue plasminogen activator (tPA). Low- or high-admission BP indicates cardiac comorbidity or preexisting hypertension, where close monitoring and further examinations are requested to prevent poorer outcome

Objectives
Methods
Results
Conclusion
Full Text
Published version (Free)

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call