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Low blood pressure during the acute period of ischemic stroke is associated with decreased survival

Wohlfahrt, Petera,b,c; Krajcoviechova, Alenaa; Jozifova, Mariea; Mayer, Ottod; Vanek, Jirid; Filipovsky, Jand; Cifkova, Renataa,b,e

doi: 10.1097/HJH.0000000000000414
ORIGINAL PAPERS: Stroke

Objectives: There is no agreement on optimal blood pressure (BP) level during the acute phase of stroke, because studies on the relation between BP and stroke outcome have shown contradicting results. The aim of this study was to compare the relationship of admission, maximal, discharge BP and its components during hospitalization for the first-ever acute ischemic stroke with total mortality after stroke.

Methods: In 532 consecutive patients (mean age 66 ± 10 years, 59% of men) hospitalized for their first-ever ischemic stroke, the association between BP and total mortality during a median follow-up of 66 weeks (interquartile range 33–119 weeks) was analyzed.

Results: In multivariate analysis, both admission mean BP (MBP) and discharge SBP quartiles were independent predictors of mortality and outperformed other parameters of BP. After multivariate adjustments, patients with admission MBP below 100 mmHg had a higher risk of death than those with MBP between 100–110 and 110–121 mmHg, whereas the risk of mortality did not differ from the group with admission MBP above 122 mmHg. Similarly, patients with discharge SBP below 120 mmHg had an increased risk of death as compared to groups with SBP between 120–130 and 130–141 mmHg, whereas the risk of death was similar to that with discharge SBP above 141 mmHg.

Conclusion: Among patients hospitalized for their first-ever ischemic stroke, the risk of all-cause death is significantly increased in those with admission MBP below 100 mmHg and discharge SBP below 120 mmHg, even after adjustments for other confounders.

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aCenter for Cardiovascular Prevention of the First Faculty of Medicine, Charles, University and Thomayer Hospital, Prague

bInternational Clinical Research Center, St Ann's University Hospital, Brno

cDepartment of Preventive Cardiology, Institute for Clinical and Experimental, Medicine, Prague

d2nd Department of Internal Medicine, Charles University, Center for Hypertension, Pilsen

eDepartment of Cardiology and Angiology, First Faculty of Medicine, Charles, University, Prague, Czech Republic

Correspondence to Peter Wohlfahrt, MD, PhD, Center for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer Hospital, Videnska 800, 140 59 Prague 4, Czech Republic. Tel: +420 261 083 694; fax: +420 261 083 821; e-mail: wohlfp@gmail.com

Abbreviations: BP, blood pressure; CCS, Causative Classification of Stroke System; IQR, interquartile range; MBP, mean blood pressure; NIHSS, National Institute of Health Stroke Scale; PP, pulse pressure

Received 26 June, 2014

Revised 8 September, 2014

Accepted 8 September, 2014

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://www.jhypertension.com).

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