High blood pressure in early acute stroke: a sign of a poor outcome?

OBJECTIVE: To evaluate the prognostic value of admission blood pressure in patients with acute ischemic stroke by determining whether it contributes to clinical outcome and vascular death. METHODS: We studied 230 consecutive patients admitted within the first 24 h after the onset of ischemic stroke. We used the first systolic and diastolic blood pressure measurements recorded on admission. The functional outcome was assessed on the basis of mortality or dependency (Rankin Scale > 3) at the 10-day and 6-month visits. RESULTS: High systolic blood pressure on admission was associated with poor outcome at the 10-day and 6-month visits, independent of the baseline risk factors but not of the severity of the initial stroke (odds ratio, 1.39; 95% confidence interval, 0.50-3.87). The spontaneous decrease in systolic blood pressure within the first 10 days was higher in patients with functional improvement. The admission blood pressure was not significantly associated with total and vascular deaths, except for a threshold effect of diastolic blood pressure. CONCLUSIONS: After an acute stroke, the relationship between blood pressure and clinical outcome depended on the severity of the stroke on presentation, and on the level and trend of the systolic blood pressure during the first 24 h.     

Relationship between outcome and baseline blood pressure and other haemodynamic measures in acute ischaemic stroke: data from the TAIST trial

BACKGROUND: A poor outcome after stroke is associated independently with high blood pressure during the acute phase; however, relationships with other haemodynamic measures [heart rate (HR), pulse pressure (PP), rate-pressure product (RPP)] remain less clear. METHODS: The Tinzaparin in Acute Ischaemic Stroke Trial is a randomised, controlled trial assessing the safety and efficacy of tinzaparin versus aspirin in 1484 patients with acute ischaemic stroke. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and HR measurements taken immediately prior to randomization were averaged, and the mid-blood pressure (MBP), PP, mean arterial pressure (MAP), pulse pressure index, and RPP were calculated. The relationship between these haemodynamic measures and functional outcome (death or dependency, modified Rankin Scale > 2) and early recurrent stroke, were studied with adjustment for baseline prognostic factors and treatment group. Odds ratios (OR) and 95% confidence intervals (CI) refer to a change in haemodynamic measure by 10 points. RESULTS: A poor functional outcome was associated with SBP (adjusted OR; 1.11; 95% CI, 1.03-1.21), HR (adjusted OR; 1.15; 95% CI, 1.00-1.31), MBP (adjusted OR; 1.15, 95% CI, 1.03-1.29), PP (adjusted OR; 1.14; 95% CI, 1.02-1.26), MAP (adjusted OR; 1.15; 95% CI, 1.02-1.31) and RPP (adjusted OR; 1.01; 95% CI, 1.00-1.02). Early recurrent stroke was associated with SBP, DBP, MBP and MAP. CONCLUSIONS: A poor outcome is independently associated with elevations in blood pressure, HR and their derived haemodynamic variables, including PP and the RPP. Agents that modify these measures may improve functional outcome after stroke.     

Prevalence, awareness, treatment, and control of hypertension in the elderly: the Three City study

OBJECTIVE: To study management of hypertension in the elderly in a large population-based study and to evaluate the prevalence of hypertension and factors related to awareness, treatment, and control. DESIGN: The Three City study, a population-based study among 9693 non-institutionalized individuals aged 65 years and over. METHODS: Blood pressure was measured with an automated electronic device, and treatment assessed, during home interview. Hypertension was defined by a mean blood pressure of two measurements superior to or equal to 160/95 mmHg and/or the intake of antihypertensive medications. RESULTS: In the final working sample of 9090 people, 62% were hypertensive. More than two-thirds were aware of their hypertension and 81% were treated with antihypertensive drugs. Among 4573 treated hypertensive participants, 35% had a blood pressure over 160/95 mmHg and 69% over 140/90 mmHg. Women were more frequently aware of their hypertension, more frequently treated, and more frequently controlled than men. A history of cardiovascular disease, high body mass index, diabetes and high frequency of visits to the general practitioner were related to higher percentages of awareness and treatment. Among treated hypertensive patients, those with a history of cardiovascular events or who visited their general practitioner more often or who more often had their blood pressure measured were more frequently controlled. Awareness was strongly associated with treatment, but was inversely related to control of hypertension among treated hypertensive patients. CONCLUSIONS: Management of hypertension, and particularly its control among treated hypertensive patients, needs to be improved in people aged 65 years and over.