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October 27, 2003

Detrimental effect of blood pressure reduction in the first 24 hours of acute stroke onset

October 28, 2003 issue
61 (8) 1047-1051

Abstract

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.

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Information & Authors

Information

Published In

Neurology®
Volume 61Number 8October 28, 2003
Pages: 1047-1051
PubMed: 14581662

Publication History

Received: March 19, 2003
Accepted: July 26, 2003
Published online: October 27, 2003
Published in print: October 28, 2003

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Authors

Affiliations & Disclosures

J. Oliveira-Filho, MD PhD
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.
S.C.S. Silva, 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.
C.C. Trabuco, 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.
B.B. Pedreira, 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.
E.U. Sousa, 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.
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.

Notes

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: [email protected]

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