TY - JOUR
T1 - The impact of blood pressure hemodynamics in acute ischemic stroke
T2 - A prospective cohort study
AU - Stead, Latha Ganti
AU - Enduri, Sailaja
AU - Bellolio, M. Fernanda
AU - Jain, Anunaya R.
AU - Vaidyanathan, Lekshmi
AU - Gilmore, Rachel M.
AU - Kashyap, Rahul
AU - Weaver, Amy L.
AU - Brown, Robert D.
N1 - Funding Information:
Besides the routine demographics, data on stroke severity on arrival, disability at hospital discharge and death at 90 days were collected for the study cohort. Stroke severity on arrival was measured by the National Institutes of Health Stroke Scale (NIHSS), and disability at discharge was measured by the modified Rankin score (mRS). Poor functional outcome was defined as a mRS ≥ 3 at discharge. Death at 3 months was ascertained by scripted telephone follow-up, state death certificates and electronic medical records with prior patient authorization.
PY - 2012
Y1 - 2012
N2 - Objective: To assess relationships between blood pressure hemodynamic measures and outcomes after acute ischemic stroke, including stroke severity, disability and death. Methods: The study cohort consisted of 189 patients who presented to our emergency department with ischemic stroke of less than 24 hours onset who had hemodynamic parameters recorded and available for review. Blood pressure (BP) was non-invasively measured at 5 minute intervals for the length of the patient's emergency department stay. Systolic BP (sBP) and diastolic BP (dBP) were measured for each patient and a differential (the maximum minus the minimum BP) calculated. Three outcomes were studied: stroke severity, disability at hospital discharge, and death at 90 days. Statistical tests used included Spearman correlations (for stroke severity), Wilcoxon test (for disability) and Cox models (for death). Results: Larger differentials of either dBP (p = 0.003) or sBP (p < 0.001) were significantly associated with more severe strokes. A greater dBP (p = 0.019) or sBP (p = 0.036) differential was associated with a significantly worse functional outcome at hospital discharge. Those patients with larger differentials of either dBP (p = 0.008) or sBP (0.007) were also significantly more likely to be dead at 90 days, independently of the basal BP. Conclusion: A large differential in either systolic or diastolic blood pressure within 24 hours of symptom onset in acute ischemic stroke appears to be associated with more severe strokes, worse functional outcome and early death
AB - Objective: To assess relationships between blood pressure hemodynamic measures and outcomes after acute ischemic stroke, including stroke severity, disability and death. Methods: The study cohort consisted of 189 patients who presented to our emergency department with ischemic stroke of less than 24 hours onset who had hemodynamic parameters recorded and available for review. Blood pressure (BP) was non-invasively measured at 5 minute intervals for the length of the patient's emergency department stay. Systolic BP (sBP) and diastolic BP (dBP) were measured for each patient and a differential (the maximum minus the minimum BP) calculated. Three outcomes were studied: stroke severity, disability at hospital discharge, and death at 90 days. Statistical tests used included Spearman correlations (for stroke severity), Wilcoxon test (for disability) and Cox models (for death). Results: Larger differentials of either dBP (p = 0.003) or sBP (p < 0.001) were significantly associated with more severe strokes. A greater dBP (p = 0.019) or sBP (p = 0.036) differential was associated with a significantly worse functional outcome at hospital discharge. Those patients with larger differentials of either dBP (p = 0.008) or sBP (0.007) were also significantly more likely to be dead at 90 days, independently of the basal BP. Conclusion: A large differential in either systolic or diastolic blood pressure within 24 hours of symptom onset in acute ischemic stroke appears to be associated with more severe strokes, worse functional outcome and early death
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U2 - 10.1186/1865-1380-5-3
DO - 10.1186/1865-1380-5-3
M3 - Review article
C2 - 22252037
AN - SCOPUS:84860564027
SN - 1865-1372
VL - 5
JO - International Journal of Emergency Medicine
JF - International Journal of Emergency Medicine
IS - 1
M1 - 3
ER -