Abstract. Vemmos KN, Tsivgoulis G, Spengos K, Zakopoulos N, Synetos A, Manios E, Konstantopoulou P, Mavrikakis M (University of Athens, 'Alexandra' Hospital; and University of Athens, 'Eginition' Hospital; Athens, Greece). U-shaped relationship between mortality and admission blood pressure in patients with acute stroke. J Intern Med 2004; 255: 257-265.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 ¼ 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 ¼ 0.005) more frequent in patients with high admission SBP-values, whereas death due to cardiovascular disease was more frequent (P ¼ 0.004) in patients with low admission SBPvalues. 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.

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Objective: To evaluate the impact of meteorological variables on daily and monthly deaths caused by acute myocardial infarction (AMI). Methods: All death certificate data from the Athens territory were analysed for AMI deaths in 2001. Daily atmospheric temperature, pressure and relative humidity data were obtained from the National Meteorological Society for Athens for the same year. Results: The total annual number of deaths caused by AMI was 3126 (1953 men) from a population of 2 664 776 (0.117%). Seasonal variation in deaths was significant, with the average daily AMI deaths in winter being 31.8% higher than in summer (9.89 v 7.35, p , 0.001). Monthly variation was more pronounced for older people (mean daily AMI deaths of people older than 70 years was 3.53 in June and 7.03 in December; p , 0.001) and of only marginal significance for younger people. The best predictor of daily AMI deaths was the average temperature of the previous seven days; the relation between daily AMI deaths and seven-day average temperature (R 2 = 0.109, p , 0.001) was U-shaped. Considering monthly AMI death rates, only mean monthly humidity was independently associated with total deaths from AMI (R 2 = 0.541, p = 0.004). Conclusion: Ambient temperature is an important predictor of AMI mortality even in the mild climate of a Mediterranean city like Athens, its effects being predominantly evident in the elderly. Mean monthly humidity is another meteorological factor that appears to affect monthly numbers of AMI deaths. These findings may be useful for healthcare and civil protection planning.

Elevated 24-h SBP values in the acute stroke period are associated with subsequent brain oedema formation.