Impaired blood pressure increase in acute cardioembolic stroke

Studies on the prognostic significance of blood pressure (BP) increases during the acute phase of ischemic stroke give contradictory results. The aim of this study was to evaluate BP response during the acute phase in different ischemic stroke subtypes, and to assess the prognostic value, considering long-term outcome, of different BP patterns recorded.

We included 110 ischemic stroke patients hospitalized within 6 h of the onset of symptoms. All the patients underwent 24-h monitoring on hospital admission and on day 7 after stroke. For statistical analysis the whole population was divided into cardioembolic (CE), atherothrombotic (AT) and lacunar (LAC) groups, according to TOAST (Trial of Org 10172 in Acute Stroke Treatment) criteria.

In both the whole population and in all subgroups systolic and diastolic BP were higher at admission than during monitoring on day 7, the lowest values being recorded in the CE subgroup. CE stroke was significantly related to lower BP (systolic and diastolic) values (P = 0.01) during the acute phase and CE patients were characterized by poorer outcome. A history of diabetes was a predictor of higher systolic and diastolic BP on the first day of monitoring; higher systolic and diastolic BP values were related to a history of hypertension and with male gender, respectively. Predictors of death by 6-months were atrial fibrillation, age and history of hypertension (P < 0.05) while higher systolic BP in the acute phase seems to represent a protective factor.

CE stroke shows a lack of BP response during the acute phase of ischemic stroke. This phenomenon is associated with a poor long-term outcome and seems not be related with cardiac co-morbidity.