NEUROLOGY 2003;61:1047-1051
© 2003 American Academy of Neurology
Detrimental effect of blood pressure reduction in the first 24 hours of acute stroke onset
J. Oliveira-Filho, MD PhD,
S.C.S. Silva, MD,
C.C. Trabuco, MD,
B.B. Pedreira, MD,
E.U. Sousa, MD and
A. Bacellar, MD
From the Department of Biomorphology (Dr. Oliveira-Filho), Health Sciences Institute, Federal University of Bahia; the Neurology Service (Drs. Oliveira-Filho, Silva, Trabuco, Pedreira, and Bacellar), Hospital Sao Rafael, Monte Tabor Foundation; and the Bahian School of Medicine and Public Health (Dr. Sousa), Salvador-Bahia, Brazil.
Address correspondence and reprint requests to Dr. Jamary Oliveira-Filho, Rua Prof. Sabino Silva, 282, apt. 701: Jardim Apipema, Salvador, BA 40155-250, Brazil; e-mail: jamaryof{at}ufba.br
Background: High blood pressure, although the main modifiable risk factor for stroke, may have a beneficial effect in maintaining brain perfusion after acute ischemia. The authors assessed the effects of blood pressure variation in the first 24 hours of stroke onset.
Methods: The authors prospectively studied consecutive patients admitted in the first 24 hours after stroke onset. Patients were classified according to the NIH Stroke Scale (NIHSS) and Oxfordshire Stroke Classification Scale (OSCS). Stroke etiology was defined according to Trial of ORG 10172 in Acute Stroke Treatment classification. After 3 months, outcome was assessed using Rankin and Barthel scales, with poor outcome defined as Rankin score > 2 or Barthel score < 70.
Results: A total of 115 patients were admitted between January 2001 and October 2002. Median NIHSS was 4.5; main stroke etiology was cardioembolism (30%). After 3 months, 44 (39%) patients had a poor outcome. Predictors of poor outcome in univariable analyses (p < 0.05) were as follows: total anterior circulation classification on OSCS, nonlacunar stroke etiology, older age, higher NIHSS score, lack of antiplatelet use, higher body temperature, lower diastolic blood pressure on admission, and a larger degree of systolic blood pressure reduction. In the multivariable analysis, remaining predictors of poor outcome included the following: NIHSS score (OR = 1.55 per 1 point increase; 95% CI = 1.28 to 1.87; p < 0.001) and degree of systolic blood pressure reduction in the first 24 hours (OR = 1.89 per 10% decrease; 95% CI = 1.02 to 3.52; p = 0.047).
Conclusion: Blood pressure reduction in the first 24 hours of stroke onset is independently associated with poor outcome after 3 months.
Received March 19, 2003.
Accepted in final form July 26, 2003.
See also page 1030
This article has been cited by other articles:
|
|
|
|
 
S. Martin-Schild, H. Hallevi, K. C. Albright, A. M. Khaja, A. D. Barreto, N. R. Gonzales, J. C. Grotta, and S. I. Savitz
Aggressive Blood Pressure-Lowering Treatment Before Intravenous Tissue Plasminogen Activator Therapy in Acute Ischemic Stroke
Arch Neurol,
September 1, 2008;
65(9):
1174 - 1178.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. I. Qureshi
Acute Hypertensive Response in Patients With Stroke: Pathophysiology and Management
Circulation,
July 8, 2008;
118(2):
176 - 187.
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. K. Shin, M. Nishimura, P. B. Jones, H. Ay, D. A. Boas, M. A. Moskowitz, and C. Ayata
Mild Induced Hypertension Improves Blood Flow and Oxygen Metabolism in Transient Focal Cerebral Ischemia
Stroke,
May 1, 2008;
39(5):
1548 - 1555.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Yong and M. Kaste
Association of Characteristics of Blood Pressure Profiles and Stroke Outcomes in the ECASS-II Trial
Stroke,
February 1, 2008;
39(2):
366 - 372.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. B. Goldstein
Acute Ischemic Stroke Treatment in 2007
Circulation,
September 25, 2007;
116(13):
1504 - 1514.
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al.
Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists.
Circulation,
May 22, 2007;
115(20):
e478 - e534.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al.
Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/ American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists
Stroke,
May 1, 2007;
38(5):
1655 - 1711.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. Gonzalez-Martinez, S. Navarro-Gutierrez, J. de Leon-Belmar, L.G. Stead, R. Gilmore, W. Decker, A. Weaver, and R.D. Brown
Initial emergency department blood pressure as predictor of survival after acute ischemic stroke
Neurology,
May 23, 2006;
66(10):
1609 - 1609.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Yong, H.-C. Diener, M. Kaste, and J. Mau
Characteristics of Blood Pressure Profiles as Predictors of Long-Term Outcome After Acute Ischemic Stroke
Stroke,
December 1, 2005;
36(12):
2619 - 2625.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. G. Stead, R. M. Gilmore, W. W. Decker, A. L. Weaver, and R. D. Brown Jr
Initial emergency department blood pressure as predictor of survival after acute ischemic stroke
Neurology,
October 25, 2005;
65(8):
1179 - 1183.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. P. Mattle, L. Kappeler, M. Arnold, U. Fischer, K. Nedeltchev, L. Remonda, S. M. Jakob, and G. Schroth
Blood Pressure and Vessel Recanalization in the First Hours After Ischemic Stroke
Stroke,
February 1, 2005;
36(2):
264 - 268.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. J. Ingall, P.K. Lindenauer, M.C. Mathew, T.S. Ntuli, P.S. Pekow, J. Fitzgerald, and E.M. Benjamin
Use of antihypertensive agents in the management of patients with acute ischemic stroke
Neurology,
January 25, 2005;
64(2):
401 - 402.
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. Mak, K. H. Chan, R. T.F. Cheung, and S. L. Ho
Hypertensive encephalopathy: BP lowering complicated by posterior circulation ischemic stroke
Neurology,
September 28, 2004;
63(6):
1131 - 1132.
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. K. Lindenauer, M. C. Mathew, T. S. Ntuli, P. S. Pekow, J. Fitzgerald, and E. M. Benjamin
Use of antihypertensive agents in the management of patients with acute ischemic stroke
Neurology,
July 27, 2004;
63(2):
318 - 323.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. M. Cheng, G. Birbeck, B. Vickrey, L. B. Goldstein, D. B. Matchar, J. Hoff-Lindquist, G. P. Samsa, and R. D. Horner
VA Stroke Study: Neurologist care is associated with increased testing but improved outcomes
Neurology,
May 25, 2004;
62(10):
1914 - 1915.
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. B. Goldstein
Blood Pressure Management in Patients With Acute Ischemic Stroke
Hypertension,
February 1, 2004;
43(2):
137 - 141.
[Full Text]
[PDF]
|
|
|
|
|
|
|
Falling Blood Pressure in Early Acute Stroke: A Sign of Poor Prognosis
Journal Watch Cardiology,
December 19, 2003;
2003(1219):
4 - 4.
[Full Text]
|
|
|
|
|
|
|
Falling Blood Pressure in Early Acute Stroke: A Sign of Poor Prognosis
Journal Watch (General),
November 28, 2003;
2003(1128):
1 - 1.
[Full Text]
|
|
|
|
|
|
|
Blood Pressure in Acute Stroke: Which Way Should It Go?
Journal Watch Neurology,
November 20, 2003;
2003(1120):
3 - 3.
[Full Text]
|
|
|
|
|
|
|
K. C. Johnston and S. A. Mayer
Blood pressure reduction in ischemic stroke: A two-edged sword?
Neurology,
October 28, 2003;
61(8):
1030 - 1031.
[Full Text]
[PDF]
|
|
|
|
