Admission Blood Pressure Values Research Articles

Predictive value of admission blood pressure for 3-month mortality in patients undergoing revascularization for critical limb ischemia.

In patients with critical limb ischemia (CLI), blood pressure (BP) impact on mortality is unknown. We analyzed the predictive value of SBP, DBP and pulse pressure (PP) at hospital admission on 3-month mortality in patients with CLI undergoing revascularization procedure. From November 2013 to December 2018, 297 consecutive patients were retrospectively included. Admission BP was recorded using automated brachial sphygmomanometer, before revascularization procedure. A median of seven (IQR3-13) separate readings were recorded for each patient and the average represented patient's mean BP (mBP). Clinical and biological parameters were recorded at baseline. The cohort included 163 men (55%) and 134 women (45%) with a mean age of 77.7 ± 11.9 years. Treated hypertension and diabetes were present in, respectively, 62 and 48% of patients. Mean SBP, DBP and PP were 132 ± 18, 70 ± 8 and 62 ± 16 mmHg. Thirty-four patients (11.4%) died during 3-month follow-up, mostly from cardiovascular causes. In univariate analysis, age, female sex, brain natriuretic peptide and C-reactive protein were positively correlated with mortality. BMI, mSBP, mDBP, mPP, hemoglobin, serum albumin and statin treatment were negatively correlated with mortality. In single-pressure multivariate analyses, mSBP (P = 0.024) and mPP (P = 0.030) were negatively correlated with mortality. Association between mSBP and mortality had an asymptotic curve pattern and SBP level 135 mmHg or less was significantly correlated with mortality. In patients undergoing revascularization for CLI, admission SBP is an independent predictor for short-term mortality with a negative relationship. SBP level 135 mmHg or less represents a warning sign to explore and correct associated comorbidities.

Has Admission Blood Pressure Any Prognostic Value in Patients With Subarachnoid Hemorrhage: An Emergency Department Experience

Hypertension is a well-known risk factor for the development and rupture of cerebral aneurysms. The authors conducted a study to investigate the prognostic value of admission blood pressure (BP) on prognosis in patients with subarachnoid hemorrhage (SAH). Two hundred patients with SAH were divided into two groups according to Hunt Hess score (good prognosis: 1 to 3, and poor prognosis: 4 and 5) and according to death in hospital (surveyed and died). The prognostic factors of SAH and BP changes according to Hunt Hess scores in the acute stages of the event were evaluated. Admission mean arterial BP values of the patients who died in hospital were significantly lower than in the patients who were surveyed (P=.026). The admission mean arterial BP values were found to be lower in the poor prognostic patients (Hunt Hess score of 4 and 5) (P<.001). Decreased admission BP values were found to be associated with poor prognosis and mortality.

Does the Admission Blood Pressure Associate with Short- and Long Term Outcome in Stroke Patients Treated with Thrombolysis? A Single Centre Study

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.

Impact of antecedent hypertension on outcomes in patients hospitalized with severe forms of acute heart failure

Objective Even though several studies described a positive infl uence of elevated initial blood pressure on the outcome in acute heart failure (AHF), data specifi cally addressed to a population with severe AHF associated with antecedent hypertension, regardless of admission blood pressure values, are missing.Methods and results From the 4153 consecutive patients enrolled in the Czech AHF registry we selected 1343 patients who suff ered from pulmonary oedema or cardiogenic shock and compared them according to the presence of antecedent hypertension. Demographic, clinical, laboratory, treatment profi les and mortality rates were assessed and predictors of short- and long-term outcome were identifi ed. Patients with antecedent hypertension (n = 1053, 78%) were older (P < 0.001), more often women (P = 0.001), having more co-morbidities and a worse laboratory profi le. A trend for worse survival of hypertensive patients was observed when compared to a non-hypertensive cohort (1-, 2-, 3-year survival 70.0, 61.5, 55.5% vs. 72.6, 68.2, 64.0%, P= 0.062). Age and creatinine levels were independently associated with mortality during the whole follow-up period (P < 0.001). Low left ventricular ejection fraction, need of mechanical ventilation, inotropic and vasopressor support, were adversely related to inhospital mortality (P < 0.001). On the other hand, presence of initial tachycardia improved short-term outcome (P = 0.007). Long-term survival was worsened by initial atrial fi brillation (P = 0.036) and anaemia (P < 0.001) while the presence of de-novo AHF improved it (P = 0.009).Conclusions Long-term antecedent hypertension is not signifi cantly correlated with mortality after an episode of severe AHF, but probably still participates in vascular and end-organ damage. Survival of these patients is determined by other associated co-morbidities.

Effect of carotid stenosis on the prognostic value of admission blood pressure in patients with acute ischemic stroke

Background Data on the correlation between blood pressure (BP) on admission and clinical outcome in patients with acute stroke are conflicting. The aims of the present study in consecutive patients with acute ischemic stroke were to evaluate: (a) the relationship between systolic or diastolic BP on admission and mortality at 3 months; (b) the role of carotid artery disease ipsilateral to the index stroke on this relationship. Methods Consecutive patients admitted to four Italian hospitals with objectively diagnosed ischemic stroke were included in this prospective study. Results A total of 1467 patients (mean age 72.6 ± 13.2 years; males 53.3%) with acute ischemic stroke were evaluated. At 3 months, 13 patients were lost at follow-up and 133 had died (9.2%). In patients with systolic BP <140 mmHg, mortality was 11% (40/362), in patients with systolic BP between 140 and 179 mmHg 8.3% (68/823) and in patients with systolic BP ≥180 mmHg 9.2% (25/269). Patients with systolic BP <140 mmHg were more likely to die within 90 days (OR 3.4; 95% CI 1.4–8.5, p = 0.008, after adjusting for other risk factors) when compared to those with systolic BP between 140 and 179 mmHg (reference group with OR = 1.0). Systolic BP ≥180 mmHg was not associated with increased mortality (OR 0.4; 95% CI 0.1–1.3, p = 0.13). Two-hundred and thirty patients out of 1278 with anterior circulation stroke had a stenosis (≥50% on ultrasonography) or an occlusion of the internal carotid ipsilateral to the index stroke. At 3 months, 29 patients had died (12.7%). In patients with systolic BP <140 mmHg, mortality was 20.4% (11/54), in those with systolic BP between 140 and 179 mmHg 13.0% (16/123) and in those with systolic BP ≥180 mmHg 3.9% (2/51). Patients with systolic BP ≥180 mmHg were less likely to die within 90 days (OR 0.1; 95% CI 0.0–0.5, p = 0.022 after adjusting for other risk factors) compared to those with systolic BP between 140 and 179 mmHg. Systolic BP <140 mmHg was not associated with increased mortality (OR 6.3; 95% CI 0.8–48.0, p = 0.08). Conclusions In the overall population, low BP was an independent risk factor for mortality. In patients with stenosis ≥50% or occlusion of the carotid ipsilateral to the index stroke, high BP was associated with a lower mortality at 3 months.

Prognostic Value of Admission Blood Pressure in Traumatic Brain Injury: Results from The IMPACT Study

Hypotension following traumatic brain injury (TBI) is recognized as an important secondary insult that is associated with adverse outcome. We aimed to describe the relationship between actual levels of admission blood pressure and Glasgow Outcome Scale (GOS) at 6 months. Individual patient data from the IMPACT database were available on systolic (N = 6801) and mean arterial (N = 6647) blood pressure. Regression models with restricted cubic spline functions were used to explore the shape of the relationships between blood pressure and outcome in unadjusted and adjusted analyses. Proportional odds methodology was applied to quantify the strength of the associations across the full range of the GOS. Analyses were performed to search for threshold values. A smooth U-shaped relationship was observed between systolic (SBP) and mean arterial (MABP) blood pressures and outcome, without any evidence of an abrupt threshold effect. Best outcomes were observed for values of SBP of the order of 135 mm Hg and for values of MABP of the order of 90 mm Hg. Both lower (OR 1.53; 95% CI: 1.31-1.80) and higher levels (OR 1.42; CI: 1.20-1.68) of SBP and lower (OR 1.30; CI 1.12-1.51) and higher levels of MABP (OR 1.45; CI 1.19-1.76) were associated with poorer outcome. These findings were consistent across studies. The relationship between high blood pressure level and poorer outcome largely disappeared on adjusted analysis. Current guidelines for the management of blood pressure in TBI focus on the avoidance of hypotension as defined by SBP < 90 mm Hg. Our finding of a smooth relationship with improving outcome as SBP increases up to 135 mm Hg, while not supporting a strong causal inference, does suggest that current guidelines need to be reconsidered.

High blood pressure in early acute stroke: a sign of a poor outcome?

To evaluate the prognostic value of admission blood pressure in patients with acute ischemic stroke by determining whether it contributes to clinical outcome and vascular death. We studied 230 consecutive patients admitted within the first 24 h after the onset of ischemic stroke. We used the first systolic and diastolic blood pressure measurements recorded on admission. The functional outcome was assessed on the basis of mortality or dependency (Rankin Scale > 3) at the 10-day and 6-month visits. High systolic blood pressure on admission was associated with poor outcome at the 10-day and 6-month visits, independent of the baseline risk factors but not of the severity of the initial stroke (odds ratio, 1.39; 95% confidence interval, 0.50-3.87). The spontaneous decrease in systolic blood pressure within the first 10 days was higher in patients with functional improvement. The admission blood pressure was not significantly associated with total and vascular deaths, except for a threshold effect of diastolic blood pressure. After an acute stroke, the relationship between blood pressure and clinical outcome depended on the severity of the stroke on presentation, and on the level and trend of the systolic blood pressure during the first 24 h.

Prognostic value of admission blood pressure in patients with intracerebral hemorrhage. Keio Cooperative Stroke Study.

Patients with acute stroke on admission to the hospital are often found to have high blood pressure. The purpose of the present study was to investigate the prognostic value of admission blood pressure in patients with acute intracerebral hemorrhage, including putaminal, thalamic, subcortical, cerebellar, and pontine hemorrhage. A total of 1701 patients with intracerebral hemorrhage of the putamen (n = 776; mean +/- SD age, 58 +/- 14 years) thalamus (n = 538; 63 +/- 12 years), subcortex (n = 153; 61 +/- 16 years), cerebellum (n = 110; 64 +/- 11 years), and pons (n = 124; 59 +/- 13 years) were examined. The mean blood pressure on admission in patients with a fatal outcome was compared with that in patients who survived. The mean age in each patient group (putaminal, thalamic, subcortical, cerebellar, and pontine hemorrhage) with fatal outcome was older than that with nonfatal outcome, while ANCOVA indicated no correlation between age and blood pressure on admission or age and volume of hematoma. The mean arterial blood pressure on hospital admission was 126.9 +/- 25.8 mm Hg (+/-SD) in cases of putaminal. 127.4 +/- 22.6 mm Hg in thalamic, 116.4 +/- 20.6 mm Hg in subcortical, 123.5 +/- 23.9 mm Hg in cerebellar, and 133.0 +/- 26.0 mm Hg in pontine hemorrhage. The mean blood pressure on admission in patients with a fatal outcome among those with putaminal (136.0 +/- 36.3 mm Hg) and thalamic (133.2 +/- 22.1 mm Hg) hemorrhage was significantly higher than that in those with a nonfatal outcome (123.8 +/- 20.6 mm Hg for putaminal, 101.6 +/- 22.5 mm Hg for thalamic) (P < .01). No correlation between mean blood pressure and outcome was observed in the patients with subcortical (116.5 +/- 22.2 mm Hg for nonfatal, 114.9 +/- 22.0 mm Hg for fatal outcome), cerebellar (125.2 +/- 22.2 mm Hg, 116.9 +/- 28.8 mm Hg), and pontine (129.9 +/- 23.8 mm Hg, 136.0 +/- 27.7 mm Hg) hemorrhage. The volume of hematoma on admission in patients with fatal outcome with putaminal (58.2 +/- 24.4 mL), thalamic (27.0 +/- 13.1 mL), subcortical (32.9 +/- 14.4 mL), and cerebellar (31.4 +/- 28.6 mL) hemorrhage was greater than that in those with nonfatal outcome (20.8 +/- 11.4 mL, 7.1 +/- 4.8 mL, 18.3 +/- 10.6 mL, and 8.1 +/- 4.2 mL, respectively; P < .01), while no correlation between volume of hematoma and outcome was observed in patients with pontine hemorrhage. The above data suggest that an increased mean blood pressure and volume of hematoma on admission in putaminal and thalamic hemorrhage were related to increased mortality, while in patients with subcortical, cerebellar, and pontine hemorrhage, the mean blood pressure was not related to the clinical outcome.

The prognostic value of admission blood pressure in patients with acute stroke.

Patients with acute stroke are often found to have high blood pressures at hospital admission. Previous studies have shown variable results regarding the prognostic value of high blood pressure in acute stroke. The aim of this study was to investigate the prognostic value of admission blood pressure in a population-based sample of patients with acute stroke. Eighty-five patients with intracerebral hemorrhage and 831 with ischemic disease were included in the study. The relations between admission blood pressure and 30-day mortality were studied by logistic regression analyses. High blood pressure in patients with impaired consciousness on hospital admission was significantly related to 30-day mortality in patients with intracerebral hemorrhage (P = .037) and in patients with ischemic disease (P < .0001). In patients without impaired consciousness, high blood pressure at time of admission was not related to increased mortality at 30 days. High admission blood pressure in alert stroke patients was not related to increased mortality. Stroke patients with impaired consciousness showed higher mortality rates with increasing blood pressure. However, this does not provide a basis for recommending antihypertensive therapy for such patients.