Skip to main content
Article thumbnail
Location of Repository

Relationship between hyperacute blood pressure and outcome after ischemic stroke: data from the VISTA Collaboration

By Gillian M. Sare, Myzoon Ali, Ashfaq Shuaib and Philip M.W. Bath

Abstract

Background and Purpose—High blood pressure (BP) is associated independently with poor outcome after acute ischemic stroke, although in most analyses “baseline” BP was measured 24 hours or more postictus, and not during the hyperacute period.\ud Methods—Analyses included 1722 patients in hyperacute trials (recruitment 8 hours) from the Virtual Stroke\ud International Stroke Trial Archive (VISTA) Collaboration. Data on BP at enrolment and after 1, 2, 16, 24, 48, and 72\ud hours, neurological impairment at 7 days (NIHSS), and functional outcome at 90 days (modified Rankin scale) were\ud assessed using logistic regression models, adjusted for confounding variables; results are for 10-mm Hg change in BP. Results—Mean time to enrolment was 3.7 hours (range 1.0 to 7.9). High systolic BP (SBP) was significantly associated\ud with increased neurological impairment (odds ratio, OR 1.06, 95% confidence interval, 95% CI 1.01 to 1.12), and poor functional outcome; odds ratios for both increased with later BP measurements made at up to 24 hours poststroke. Smaller (versus larger) declines in SBP over the first 24 hours were significantly associated with poor NIHSS scores (OR 1.16, 95% CI 1.05 to 1.27) and functional outcome (OR 1.23, 95% CI 1.13 to 1.34). A large variability in SBP was also associated with poor functional outcome.\ud Conclusions—High SBP and large variability in SBP in the hyperacute stages of ischemic stroke are associated with\ud increased neurological impairment and poor functional outcome, as are small falls in SBP over the first 24 hours

Publisher: American Heart Association
Year: 2009
OAI identifier: oai:eprints.nottingham.ac.uk:1081
Provided by: Nottingham ePrints

Suggested articles

Citations

  1. Association of characteristics of blood pressure profiles and stroke outcomes in the ECASS-II trial. doi
  2. Blood pressure after stroke.
  3. Blood pressure course in patients with acute stroke and matched controls. doi
  4. (2001). Blood pressure in Acute Stroke Collaboration. The effect of vasoactive drugs on blood pressure and outcome in acute stroke (Cochrane review). Oxford: Update Software;
  5. Characteristics of blood pressure profiles as predictors of long-term outcome after acute ischemic stroke.
  6. (2000). Dynamic but not static cerebral autoregulation is impaired in acute ischaemic stroke. Cerebrovasc Dis. doi
  7. (2009). EB; for the TAIST Investigators. The relationship between baseline blood pressure and computed tomography findings in acute stroke: data from the tinzaparin in acute ischaemic stroke trial (TAIST). doi
  8. Factors influencing admission blood pressure levels in patients with acute stroke. doi
  9. for the IST Collaborative Group. Blood pressure and clinical outcomes in the international stroke trial.
  10. Glyceryl trinitrate vs control, and continuing vs stopping temporarily prior antihypertensive therapy, in acute stroke: rationale and design of the efficacy of nitric oxide in stroke (ENOS) trial (ISRCTN99414122). doi
  11. Impact of acute blood pressure variability on ischemic stroke outcome. doi
  12. Lindenstrom E, for the TAIST investigators. Relationship between outcome and baseline blood pressure and other haemodynamic measures in acute ischaemic stroke: Data from the TAIST trial.
  13. Nitric oxide and focal cerebral ischemia: Multiplicity of actions and diverse outcome. Cerebrovasc Brain Metab Rev.
  14. (1994). Textbook of Hypertension. doi
  15. (2003). The effects of transdermal glyceryl trinitrate, a nitric oxide donor on blood pressure, cerebral and cardiac haemodynamics and plasma nitric oxide levels in acute stroke. J Stroke Cerebrovasc Dis. doi
  16. The virtual international stroke trials archive. doi

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.