The impact of blood pressure hemodynamics in acute ischemic stroke: A prospective cohort study

• Type of Material: Article
• Authors: Latha Ganti Stead, Mayo Medical School; Sailaja Enduri, Mayo Medical School; M Fernanda Bellolio, Mayo Medical School; Anunaya R Jain, Mayo Medical School; Lekshmi Kumar, Emory University; Rachel M Gilmore, Mayo Medical School; Rahul Kashyap, Mayo Medical School; Amy L Weaver, Mayo Medical School; Robert D Brown, Mayo Medical School
• Language: English
• Date: 2012-05-09
• Publisher: BMC (part of Springer Nature)
• Publication Version: Final Published Version
• Copyright Statement: ©2012 Stead et al; licensee Springer.
• License: Creative Commons Attribution 2.0 Generic
• Final Published Version (URL): http://dx.doi.org/10.1186/1865-1380-5-3
• Title of Journal or Parent Work: International Journal of Emergency Medicine
• ISSN: 1865-1372
• Volume: 5
• Issue: 1
• Start Page: 3
• End Page: 3
• Keywords: Emergency Department Stay; Large Differential; Acute Ischemic Stroke; Blood Pressure Variability; Stroke Severity
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Rehabilitation and Therapy

Abstract

Objective: To assess relationships between blood pressure hemodynamic measures and outcomes after acute ischemic stroke, including stroke severity, disability and death. Methods: The study cohort consisted of 189 patients who presented to our emergency department with ischemic stroke of less than 24 hours onset who had hemodynamic parameters recorded and available for review. Blood pressure (BP) was non-invasively measured at 5 minute intervals for the length of the patient's emergency department stay. Systolic BP (sBP) and diastolic BP (dBP) were measured for each patient and a differential (the maximum minus the minimum BP) calculated. Three outcomes were studied: stroke severity, disability at hospital discharge, and death at 90 days. Statistical tests used included Spearman correlations (for stroke severity), Wilcoxon test (for disability) and Cox models (for death). Results: Larger differentials of either dBP (p = 0.003) or sBP (p < 0.001) were significantly associated with more severe strokes. A greater dBP (p = 0.019) or sBP (p = 0.036) differential was associated with a significantly worse functional outcome at hospital discharge. Those patients with larger differentials of either dBP (p = 0.008) or sBP (0.007) were also significantly more likely to be dead at 90 days, independently of the basal BP. Conclusion: A large differential in either systolic or diastolic blood pressure within 24 hours of symptom onset in acute ischemic stroke appears to be associated with more severe strokes, worse functional outcome and early death