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Twenty-four hour systolic blood pressure predicts long-term mortality following acute stroke
T G Robinson1, S L Dawson, U Ahmed
1Department of Medicine, Division of Medicine for the Elderly, Leicester Warwick Medical School, University Hospitals of Leicester NHS Trust, Leicester, UK. tgr2@le.ac.uk
Objective:
To assess the effects of acute blood pressure (BP) on long-term mortality following stroke.
Design:
Prospective observational study.
Setting:
Leicester Teaching Hospitals.
Patients:
Two hundred and nineteen consecutive patients were recruited within 24 h of acute stroke.
Interventions:
Clinic and 24 h BP levels were measured. Other risk factors previously associated with stroke mortality were recorded within 24 h of admission. No specific pharmacological interventions;were made.
Main Outcome Measures:
The primary outcome measure was death over a median follow-up period of over 2.5 years. The hazards ratios associated with predefined variables were assessed using Cox's proportional hazards modelling, and Kaplan-Meier survival plots were also calculated.
Results:
On multiple variable analysis, 24 h systolic BP (> or = 160 mmHg) was associated with an increased hazards ratio of 2.41 (95% confidence intervals: 1.24-4.67) for death, compared to the reference group (140-159 mmHg). The addition of 24 h heart rate was significant, with increasing heart rate (> 83 bpm) associated with an increased mortality (P = 0.006), although this effect was not constant over time. Increasing age (> 80 years) at presentation was also associated with an increased hazards ratio of 2.53 (1.14-5.62) compared to age < or = 66 years.
Conclusions:
This study provides evidence that elevated 24 h systolic BP in the acute stroke period is associated with increased long-term mortality. This may have implications in the therapeutic management of BP following stroke, though further research is required to determine the timing, nature and effect of such an intervention.