Neurology -- Correspondence for Stead et al., 65 (8) 1179-1183

Correspondence published:

Initial emergency department blood pressure as predictor of survival after acute ischemic stroke: Félix González-Martínez, Sergio Navarro-Gutierrez and Javier de León-Belmar (20 January 2006)

Reply from the authors: Latha G. Stead, Rachel Gilmore, Wyatt Decker, Amy Weaver, Robert D. Brown Jr. (20 January 2006)

Initial emergency department blood pressure as predictor of survival after acute ischemic stroke 20 January 2006

Félix González-Martínez,
Emergency Dept. Hospital Virgen de la Luz
Emergency Dept. Hospital Virgen de la Luz. Hermandad de Donantes s/n E-16002 Cuenca (Spain),
Sergio Navarro-Gutierrez and Javier de León-Belmar
Send Correspondence to journal:
Re: Initial emergency department blood pressure as predictor of survival after acute ischemic stroke

fgonmar{at}mailpersonal.com Félix González-Martínez, et al.

We read with interest the article by Stead et al. [1] We conducted a description study under the same conditions as Stead et al from 1/10/2002 to 30/9/2003 in our Emergency Department (ED). We assessed 485 patients who were admitted to the ED with the diagnostic of acute ischemic stroke (IS). Our ED receives an estimated 60,000 visits a year.
Patient’s information included age, sex, date of ED admittance, initial blood pressure (BP), use of medication, temperature at admission, rhythm and heart rate. BP was measured using a manual sphyngmomanoter by nurses who had no knowledge of this study. We made a follow up during admission assessing the patient’s medical record.
Our objective was to assess if blood pressure in the ED could be used as a predictor of survival in patients with IS. Of 485 patients, 246 of them were men (50,7%). Sixty patients died during admission; 37 of them were women (p<0.03). Mean age among deceased patients was 80,14±7,63, while mean age in patients who survived this episode was 74,44±10,28 (p<0,001). Mean systolic BP (sBP) at admission in deceased patients was 145,08±41,45 and patients who survived had a mean sBP of 154,62±29,84 (p>0,05). Mean diastolic BP (dBP) in deceased patients was 80,80±20,16 versus 87,43±15,22 in patients who survived (p<0,02).
We agree with Stead et al because our data also suggest that early low BP in patients with acute IS measured in the ED is linked to an increased death risk. Low cerebral perfusion associated to a low BP is related to an increased mortality. Patients with low BP are more likely to die due not only to stroke. Conditions like heart failure or infections associated to stroke in patients with low BP showed an increased mortality rate.
Treatment of high BP during ischemic stroke has been widely reported [2,3] while management of low BP remains unclear. An association between low dBP and poor functional outcome after 24 hours after admission has been reported. [4] However, we measured the BP at admission in the ED relating this BP to the hospital mortality rate. Low dBP in the ED in patients with acute IS is related to an increased mortality rate.
References
1. Stead LG, Gilmore RM, Decker WW, Weaver AL, Brown RD Jr. Initial emergency department blood pressure as predictor of survival after acute ischemic stroke. Neurology. 2005;65:1179-83.
2. Bath P, Boysen G, Donnan G, et al. Hypertension in acute stroke: what to do? Stroke 2001;32:1697–1698.
3. Messerli FH, Hanley DF Jr, Gorelick, PB. Blood pressure control in stroke patients: what should the consulting neurologist advise? Neurology 2002;59:23–25.
4. Oliveira-Filho J, Silva SC, Trabuco CC, et al. Detrimental effect of blood pressure reduction in the first 24 hours of acute stroke onset. Neurology 2003;61:1047–1051.
Disclosure: The authors report no conflicts of interest.

Reply from the authors 20 January 2006

Latha G. Stead,
Mayo Clinic
Generose G-410, 200 First St SW, Rochester, MN 55905,
Rachel Gilmore, Wyatt Decker, Amy Weaver, Robert D. Brown Jr.
Send Correspondence to journal:
Re: Reply from the authors

stead.latha{at}mayo.edu Latha G. Stead, et al.

We thank Gonzalez-Martinez et al for their correspondence. Their data closely parallels ours and we agree that the relationship between low BP in the ED and outcome after acute ischemic stroke needs to be further investigated.
Disclosure: The authors report no conflicts of interest.