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SBP and antihypertensive treatment in the acute phase after stroke and its impact on the risk of falling

Kjellberg, Sigvara; Hansson, Per-Olofa; Lernfelt, Bodila; Persson, Carina U.b

doi: 10.1097/HJH.0000000000002004
ORIGINAL PAPERS: Treatment
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Introduction: Blood pressure development after acute stroke is inadequately studied. The objectives of this study were to describe SBP development among patients in the acute phase after stroke, and to investigate whether intensified antihypertensive treatment during this phase was associated with short-term prognosis regarding the risk of falling.

Patients and methods: This observational study is a sub-study of the Fall Study of Gothenburg and included 421 consecutive patients admitted to a stroke unit. Medical records were studied for blood pressure measurements, antihypertensive treatment and falls. Random coefficient models for repeated measures data was used to study change in SBP. Univariable Cox proportional hazards model was used for estimation of predictors’ effect on time to first fall within first 10 days.

Results: During the first two days after stroke onset, mean SBP for all stroke patients decreased by 14.9 mmHg (95% CI 12.3–17.4, P < 0.0001) and further 2.3 mmHg days 2–7 after onset (95% CI −0.1 to 4.7, P = 0.066). The decrease in SBP was statistically significant irrespective of the use of antihypertensive treatment. No association was found between intensified antihypertensive treatment in the first week after acute stroke and the risk of a fall.

Conclusion: The findings show a spontaneous decrease of SBP during the first two days after acute stroke. This reduction in SBP seems to be present regardless of stroke type, age and use of antihypertensive treatment. No association between intensified antihypertensive treatment during the first 7 days after stroke and falls was found.

aDepartment of Molecular and Clinical Medicine, Institute of Medicine

bRehabilitation Medicine, Department of Clinical Science, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

Correspondence to Sigvar Kjellberg, MD, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, SE-405 30 Gothenburg, Sweden. e-mail: sigvar.kjellberg@vgregion.se

Abbreviations: AIC, Akaike's Information Criterion; BP, blood pressure; CI, confidence interval; FallsGOT, Fall Study of Gothenburg; IQR, interquartile range; NIHSS, National Institutes of Health Stroke Scale; SU, Sahlgrenska University Hospital; SwePASS, The Swedish Modified Version of the Postural Assessment Scale for Stroke Patients; VGR, Region Västra Götaland

Received 19 August, 2018

Accepted 29 October, 2018

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