Abstract
Background and PurposeHydration at the time of stroke may impact functional outcomes. We sought to investigate the relationship between blood pressure, hydration status, and stroke severity in patients with acute ischemic stroke (AIS).MethodsWe evaluated hydration status, determined by blood urea nitrogen (BUN)/creatinine ratio, in consecutive patients with AIS from a single comprehensive stroke center. Baseline mean arterial pressure (MAP) was analyzed using a linear spline with a knot at 90 mmHg. Baseline stroke severity was defined based on admission NIH Stroke Scale scores (NIHSSS) and MRI diffusion-weighted imaging.ResultsAmong 108 eligible subjects, 55 (51%) presented in a volume contracted state. In adjusted models, in the total sample, for every 10 mmHg higher MAP up to 90 mmHg, NIHSSS was 2.8 points lower (p = 0.053), without further statistically significant association between MAP above 90 and NIHSSS. This relationship was entirely driven by the individuals in a volume contracted state: MAP was not associated with NIHSSS in individuals who were euvolemic. For individuals in a volume contracted state, each 10 mmHg higher MAP, up to 90 mmHg, was associated with 6.9 points lower NIHSSS (95% CI −11.1, −2.6). MAP values above 90 mmHg were not related to NIHSSS in either dehydrated or euvolemic patients.ConclusionsLower MAP contributes to more severe stroke in patients who are volume contracted, but not those who are euvolemic, suggesting that hydration status and blood pressure may jointly contribute to the outcome. Hydration status should be considered when setting blood pressure goals for patients with AIS.
Highlights
Despite advances in stroke care and identification of acute therapies for ischemic stroke, stroke remains a leading cause of adult disability. [1]
Infarct volume was calculated using baseline MRI diffusion-weighted imaging (DWI) sequences and diffusion to perfusion (PWI) mismatch calculated if perfusion study was obtained as the standard of care upon admission to the hospital using OleaSphere software (OleaSphere 3; Olea Medical, La Ciotat, France) by a single primary rater blinded to both diagnosis and hydration status
It was apparent that this relationship was entirely driven by the individuals in a volume contracted state: Mean arterial pressure (MAP) was not associated with NIHSSS in individuals who were euvolemic
Summary
Despite advances in stroke care and identification of acute therapies for ischemic stroke, stroke remains a leading cause of adult disability. [1]. A growing body of evidence suggests that patients who are dehydrated, volume contracted, or both at the time of stroke have worse functional outcomes independent of age, size of the stroke, or presence of complex comorbidities [2, 3]. The mechanism behind this relationship is yet unknown, though many hypothesize that the worse outcome is due to blood pressure variations that alter cerebral perfusion during a period of disrupted autoregulation. We sought to investigate the relationship between blood pressure, hydration status, and stroke severity in patients with acute ischemic stroke (AIS)
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