High Blood Pressure on Admission in Relation to Poor Outcome in Acute Ischemic Stroke with Intracranial Atherosclerotic Stenosis or Occlusion

Abstract

Intracranial atherosclerotic stenosis is common in Asian, black, and Hispanic individuals. However, the management of blood pressure (BP) in the setting of acute stage in these patients is controversial. The present study aims to explore the relationship between BP on admission and outcomes in acute ischemic stroke patients with intracranial atherosclerotic stenosis or occlusion. We prospectively registered consecutive cases of acute ischemic stroke from September 01, 2009, to August 31, 2011. Patients with severe intracranial stenosis or occlusion were included. Death or disability was followed up at the end of the third month. The multivariate logistic regression model was used to analyze the relationship between BP on admission and clinical outcomes. We included 215 cases, which accounted for 22.7% (215 of 946) of the total registered cases. The mean age was 60.44±13.23 years. The median time of symptoms onset to admission was 72 hours (2-270 hours). Patients with systolic blood pressure (SBP) of 120-159 mm Hg or diastolic BP of 70-89 mm Hg had the lowest death or disability. After adjustment of confounders, SBP of 160 mm Hg or more on admission was the independent predictor of death or disability at the third month (relative risk [RR], 2.89; 95% confidence interval [CI], 1.20-6.91). SBP less than 120 mm Hg on admission had a trend of increasing death or disability (RR, 1.96; 95% CI, .60-6.33). Higher BP on admission was associated with an increased risk of death or disability in patients with symptomatic intracranial artery stenosis or occlusion. It is reasonable that further studies on the effects of BP lowering in acute stroke include these patients.