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Impact of acute blood pressure variability on ischemic stroke outcome

From the Department of Emergency Medicine (L.G.S., R.M.G., W.W.D.), Division of Biostatistics (A.L.W.), and Department of Neurology (R.D.B.), Mayo Clinic, Rochester, and Department of Biomedical Engineering (K.C.V.), University of Minnesota, Minneapolis, MN.

Address correspondence and reprint requests to Dr Stead, Department of Emergency Medicine, Mayo Clinic, 200 First St. SW, Generose G-410, Rochester, MN 55905; e-mail: stead.latha{at}mayo.edu

Background: The authors previously reported a low initial emergency department (ED) blood pressure (BP) to be associated with a significantly increased risk of death at 90 days. In this article, they examine the impact of acute BP variability following onset of ischemic stroke.

Methods: The study cohort consisted of 71 patients with stroke onset less than 24 hours. BP measurements were obtained every 5 minutes for the duration of the patient’s ED stay. During the first 180 minutes, the median number of readings per patient was 9 (range 2 to 30).

Results: The baseline median systolic (sBP) and diastolic (dBP) BPs were not different for the patients that died within 90 days compared with those that were alive (p = 0.91 for sBP and p = 0.27 for dBP). Patients who died within 90 days had a greater differential in their dBP during the first 180 minutes than the patients that were alive after 90 days (median 44.5 vs 25 mm Hg; Wilcoxon rank sum test, p < 0.001). A similar result was observed for sBP (median 47 vs 30 mm Hg; p = 0.047).

Conclusion: Wide fluctuation of blood pressure in the first 3 hours of the emergency department stay in patients with acute ischemic stroke appears to be associated with an increased risk of death at 90 days.

Disclosure: The authors report no conflicts of interest.

Received August 23, 2005. Accepted in final form March 13, 2006.

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