Pulse pressure in acute stroke is an independent predictor of long-term mortality

The management of blood pressure (BP) during the acute phase of stroke remains a matter of debate. The aim of the present study was to evaluate a possible association between long-term mortality and BP values in acute stroke by means of BP monitoring. We studied a consecutive series of 198 first-ever acute stroke patients. BP monitoring was initiated in all subjects within 24 h of ictus. One year after stroke onset, 34 (17.7%) patients had died. Multivariate Cox regression analysis revealed only age, level of consciousness on admission, lacunar stroke and 24-hour pulse pressure (24-hour PP) as significant outcome predictors. The hazards ratio for 1-year mortality associated with every 10 mm Hg increase in 24 h PP was 1.39 (95% CI: 1.04-1.86, p = 0.028). The present results demonstrate that increasing 24-hour PP levels in patients with acute stroke are independently associated with higher long-term mortality. This may have implications in acute stroke BP management and warrants further investigation.