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Blood pressure and antihypertensive therapy as predictors of early outcome in acute ischemic stroke.
Cerebrovasc Dis. 2008; 25(3):202-8.CD

Abstract

BACKGROUND

The clinical impact of blood pressure (BP) and of antihypertensive therapy (AHT) in acute ischemic stroke remains uncertain.

METHODS

We reviewed the charts of patients admitted to the Montreal General Hospital between April 1, 2002 and October 15, 2005. Ischemic stroke was considered severe if the Canadian Neurological Scale at presentation was < or =7. Poor outcome at 10 days after onset was defined as a modified Rankin Scale >3. Acute change in BP was defined as the percent difference between the mean 24-hour mean arterial pressure (MAP) and the baseline MAP. AHT was considered present if administered > or =5 days during the first week after stroke onset. The association between predictors and outcome was assessed using unconditional multivariable logistic regression. Covariates used included age, stroke severity, diabetes mellitus, coronary artery disease, atrial fibrillation, premorbid hypertension and hyperlipidemia.

RESULTS

Three hundred and sixty-four patients were included. Compared to patients with intermediate baseline BP, those with a MAP >130 mm Hg [OR = 2.47 (95% CI, 1.04-5.85)] or a MAP <90 mm Hg [OR = 2.94 (95% CI, 1.28-6.77)] were found to have an increased risk of poor outcome after covariate adjustment. A 15% increase in MAP was associated with an increased risk of poor outcome [OR = 5.34 (95% CI, 1.18-24.3)] while AHT in the first week after stroke onset was found to result in a decreased risk [OR = 0.39 (95% CI, 0.17-0.90)]. However, neither of these findings remained significant after adjustment for the described covariates.

CONCLUSIONS

Both high and low MAP at presentation are associated with worse short-term outcome after ischemic stroke.

Authors+Show Affiliations

McGill University, Montreal, Que., Canada. robert.cote@mcgill.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18212508

Citation

Keezer, Mark R., et al. "Blood Pressure and Antihypertensive Therapy as Predictors of Early Outcome in Acute Ischemic Stroke." Cerebrovascular Diseases (Basel, Switzerland), vol. 25, no. 3, 2008, pp. 202-8.
Keezer MR, Yu AY, Zhu B, et al. Blood pressure and antihypertensive therapy as predictors of early outcome in acute ischemic stroke. Cerebrovasc Dis. 2008;25(3):202-8.
Keezer, M. R., Yu, A. Y., Zhu, B., Wolfson, C., & Côté, R. (2008). Blood pressure and antihypertensive therapy as predictors of early outcome in acute ischemic stroke. Cerebrovascular Diseases (Basel, Switzerland), 25(3), 202-8. https://doi.org/10.1159/000113857
Keezer MR, et al. Blood Pressure and Antihypertensive Therapy as Predictors of Early Outcome in Acute Ischemic Stroke. Cerebrovasc Dis. 2008;25(3):202-8. PubMed PMID: 18212508.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Blood pressure and antihypertensive therapy as predictors of early outcome in acute ischemic stroke. AU - Keezer,Mark R, AU - Yu,Amy Y X, AU - Zhu,Bin, AU - Wolfson,Christina, AU - Côté,Robert, Y1 - 2008/01/23/ PY - 2007/08/28/received PY - 2007/08/29/accepted PY - 2008/1/24/pubmed PY - 2008/4/18/medline PY - 2008/1/24/entrez SP - 202 EP - 8 JF - Cerebrovascular diseases (Basel, Switzerland) JO - Cerebrovasc Dis VL - 25 IS - 3 N2 - BACKGROUND: The clinical impact of blood pressure (BP) and of antihypertensive therapy (AHT) in acute ischemic stroke remains uncertain. METHODS: We reviewed the charts of patients admitted to the Montreal General Hospital between April 1, 2002 and October 15, 2005. Ischemic stroke was considered severe if the Canadian Neurological Scale at presentation was < or =7. Poor outcome at 10 days after onset was defined as a modified Rankin Scale >3. Acute change in BP was defined as the percent difference between the mean 24-hour mean arterial pressure (MAP) and the baseline MAP. AHT was considered present if administered > or =5 days during the first week after stroke onset. The association between predictors and outcome was assessed using unconditional multivariable logistic regression. Covariates used included age, stroke severity, diabetes mellitus, coronary artery disease, atrial fibrillation, premorbid hypertension and hyperlipidemia. RESULTS: Three hundred and sixty-four patients were included. Compared to patients with intermediate baseline BP, those with a MAP >130 mm Hg [OR = 2.47 (95% CI, 1.04-5.85)] or a MAP <90 mm Hg [OR = 2.94 (95% CI, 1.28-6.77)] were found to have an increased risk of poor outcome after covariate adjustment. A 15% increase in MAP was associated with an increased risk of poor outcome [OR = 5.34 (95% CI, 1.18-24.3)] while AHT in the first week after stroke onset was found to result in a decreased risk [OR = 0.39 (95% CI, 0.17-0.90)]. However, neither of these findings remained significant after adjustment for the described covariates. CONCLUSIONS: Both high and low MAP at presentation are associated with worse short-term outcome after ischemic stroke. SN - 1421-9786 UR - https://www.unboundmedicine.com/medline/citation/18212508/Blood_pressure_and_antihypertensive_therapy_as_predictors_of_early_outcome_in_acute_ischemic_stroke_ L2 - https://www.karger.com?DOI=10.1159/000113857 DB - PRIME DP - Unbound Medicine ER -