Blood Pressure and Hospital Discharge Outcomes in Acute Ischemic Stroke Patients Undergoing Reperfusion Therapy |
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| Affiliation: | 2. Department of Neurology, University of New Mexico School of Medicine, Albuquerque, NM, USA;3. Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA;4. Division of Public Health, Department of Family and Preventive Medicine, Health University of Utah, Salt Lake City, UT, USA;5. Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, NM, USA;2. Department of Family & Preventive Medicine, University of Utah, Salt Lake City, Utah;3. Division of Cardiothoracic Surgery, University of New Mexico, Albuquerque, New Mexico;1. Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States;2. Huntsman Cancer Institute, Salt Lake City, UT, United States;3. Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, United States;4. Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, UT, United States;5. Intermountain Healthcare, Salt Lake City, UT, United States;6. Pedigree and Population Resources, Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, United States;7. University of Utah Health Sciences Center, Salt Lake City, UT, United States;8. Utah Cancer Registry, Salt Lake City, UT, United States;9. Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, United States;10. Department of Dermatology, University of Utah School of Medicine, Salt Lake City, UT, United States;11. Division of Oncology, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States;12. Department of Preventive Medicine, Keck School of Medicine of USC, Los Angeles, CA, United States |
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| Abstract: | IntroductionAcute management of blood pressure in ischemic stroke treated with reperfusion therapy remains uncertain. We evaluated blood pressures during the first 24-hours after reperfusion therapy in relation to in-hospital outcomes.MethodsWe conducted a single-center retrospective study of blood pressure in the first 24 hours among ischemic stroke patients who underwent reperfusion therapy with intravenous thrombolysis (IVT) or mechanical thrombectomy (MT) at a tertiary referral center. Blood pressure variability was expressed as the range between the highest and the lowest pressures. Outcomes of interest were discharge disposition and in-hospital mortality. Favorable outcome was defined as a discharge destination to home or inpatient rehabilitation facility (IRF). Multivariable logistic regression analysis was performed with adjustment for age, National Institutes of Health Stroke Scale score, and patients receiving reperfusion therapy.ResultsAmong the 140 ischemic stroke patients (117 IVT, 84 MT and 61 both), 95 (67.8%) had favorable discharge disposition and 24 (17.1%) died. Higher 24-hour peak systolic blood pressures (SBPs) and peak mean arterial pressures (MAPs) were independently associated with a lower likelihood of favorable discharge disposition, with an adjusted odds ratio (aOR) 0.868, 95 % CI 0.760 - 0.990 per 10 mm Hg for SBP and aOR 0.710, 95% CI 0.515 - 0.980 for MAP, and with increased odds of death aOR 1.244, 95% CI 1.056-1.467 and aOR 1.760, 95% CI 1.119 - 2.769 respectively. Greater variability of SBP and MAP was also associated with odds of death aOR 1.327, 95% CI 1.104 - 1.595 and aOR 1.577, 95% CI 1.060- 2.345 respectively, without a significant effect on discharge disposition.ConclusionIn the first 24 hours after reperfusion therapy, higher peak and variable blood pressures are associated with unfavorable discharge outcomes and increased in-hospital mortality. Further studies in stroke patients undergoing reperfusion therapy might target blood pressure reduction and variability to improve patient outcomes. |
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