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J Intern Med. 2004 Feb;255(2):257-65.

U-shaped relationship between mortality and admission blood pressure in patients with acute stroke.

Author information

1
Acute Stroke Unit, Department of Clinical Therapeutics, University of Athens, Athens, Greece. vemmosk@ath.forthnet.gr

Abstract

OBJECTIVE:

To evaluate the relationship between systolic blood pressure (SBP) or diastolic blood pressure (DBP) on admission and early or late mortality in patients with acute stroke.

DESIGN:

Prospective study of hospitalized first-ever stroke patients over 8 years.

SETTING:

Stroke unit and medical wards in a University hospital.

SUBJECTS:

A total of 1121 patients admitted within 24 h from stroke onset and followed up for 12 months.

MAIN OUTCOME MEASURES:

Mortality at 1 and 12 months after stroke in relation to admission SBP and DBP.

RESULTS:

Early and late mortality in patients with acute ischaemic or haemorrhagic stroke in relation to admission SBP and DBP followed a 'U-curve pattern'. After adjusting for known outcome predictors, the relative risk of 1-month and 1-year mortality associated with a 10-mmHg SBP increase above 130 mmHg (U-point of the curve) increased by 10.2% (95% CI: 4.2-16.6%) and 7.2% (95% CI: 2.2-12.3%), respectively. For every 10 mmHg SBP decrease, below the U-point, the relative risk of 1-month and 1-year mortality rose by 28.2% (95% CI: 8.6-51.3%) and 17.5% (95% CI: 3.1-34.0%), respectively. Low admission SBP-values were associated with heart failure (P < 0.001) and coronary artery disease (P = 0.006), whilst high values were associated with history of hypertension (P < 0.001) and lacunar stroke (P < 0.001). Death due to cerebral oedema was significantly (P = 0.005) more frequent in patients with high admission SBP-values, whereas death due to cardiovascular disease was more frequent (P = 0.004) in patients with low admission SBP-values.

CONCLUSION:

Acute ischaemic or haemorrhagic stroke patients with high and low admission BP-values have a higher early and late mortality. Coincidence of heart disease is associated with low initial BP-values. Death due to neurological damage from brain oedema is associated with high initial BP-values.

PMID:
14746563
[Indexed for MEDLINE]
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