High Blood Pressure After Acute Ischemic Stroke Is Associated With Poor Clinical Outcomes

Abstract

Abstract-The relationship between the poststroke blood pressure (BP) and functional outcomes in patients with acute ischemic stroke is still controversial. The aim of the present study was to elucidate the impact of the poststroke BP on the clinical outcomes of acute ischemic stroke. Among the patients in the Fukuoka Stroke Registry, 1874 patients with first-ever acute ischemic stroke (within 24 hours of onset) who had been functionally independent before onset were prospectively enrolled in the present study. The poststroke BP levels were defined as the average values during the 48 hours after onset. The study outcomes were a good neurological recovery, neurological deterioration, and a poor functional outcome. The higher poststroke BP levels were significantly associated with a lower probability of a good neurological recovery and elevated risks of neurological deterioration and a poor functional outcome after adjusting for potential confounding factors. The multivariate-adjusted odds ratios (95% confidence interval) in the highest quintile of systolic BP (versus the lowest quintile as a reference) were 0.51 (0.37-0.71) for a good neurological recovery, 1.92 (1.15-3.27) for neurological deterioration, and 2.51 (1.69-3.74) for a poor functional outcome. Similar associations were observed when we applied the poststroke diastolic BP or pulse pressure. No evidence of the J-curve phenomenon was observed for each association. These results suggest that a high poststroke BP was significantly associated with unfavorable clinical outcomes in patients with acute ischemic stroke. There was no evidence of the J-curve phenomenon between the poststroke BP levels and the clinical outcomes.

Adverse Influence of Pre-Stroke Dementia on Short-Term Functional Outcomes in Patients with Acute Ischemic Stroke: The Fukuoka Stroke Registry

“…This study was performed in accordance with the Declaration of Helsinki and its subsequent amendments. Details of the study design have been previously described [14][15][16][17][18] .…”

“…Stroke was defined as sudden onset of nonconvulsive and focal neurological deficits persisting for more than 24 h. Ischemic stroke was identified and classified into the following 4 subtypes as was reported previously: cardioembolism, large-artery atherosclerosis, small-vessel occlusion, or others (ischemic stroke of other determined or undetermined etiology) [14][15][16][17][18] . Non-cardioembolic infarction was defined as either stroke subtype as large-artery atherosclerosis, small-vessel occlusion, or other [14][15][16][17][18] .…”

“…Non-cardioembolic infarction was defined as either stroke subtype as large-artery atherosclerosis, small-vessel occlusion, or other [14][15][16][17][18] .…”

Low Pulse Pressure After Acute Ischemic Stroke is Associated With Unfavorable Outcomes: The Taiwan Stroke Registry

“…However, the occurrence of stroke may directly lead to an acute increase in BP 4, 5. Although the role of BP management after a stroke remains controversial, systolic, mean, or diastolic BP levels upon hospital arrival have demonstrated a U‐ or J‐curve association with poststroke mortality and functional dependency 6, 7, 8, 9, 10, 11, 12…”

Effects of Early Hypertension Control after Ischaemic Stroke on the Outcome: A Meta-Analysis

“…In the US National Hospital Ambulatory Medical Care Survey, 76.5% of patients with AIS had systolic blood pressures (SBPs) of 140 mm Hg or higher on arrival at the emergency department [1] . High BP is always associated with increased risk of cerebral oedema and haemorrhagic transformation, which will contribute to the poor stroke outcome [2][3][4] . In this respect, BP lowering will be beneficial, but the neutral or negative results of some randomized controlled and observational studies led us to think more about this question [5][6][7] .…”