Related Experiment Video
Updated: Aug 3, 2025
Real-Time Monitoring and Modulation of Blood Pressure in a Rabbit Model of Ischemic Stroke
Published on: February 10, 2023
Systolic blood pressure in acute ischemic stroke and impact on clinical outcomes
Michelle Wallen1, Paul Banerjee1,2, Amanda Webb-McAdams1,3
1Envision Physician Services, Plantation, FL, USA.
Insights
Higher systolic blood pressure (SBP) in acute ischemic stroke (AIS) patients presenting to the emergency department (ED) is linked to less severe strokes and better outcomes. This finding suggests SBP may be a useful prognostic indicator for AIS patients.
Area of Science:
- Neurology
- Cardiology
- Emergency Medicine
Background:
- Stroke represents a significant global health burden, contributing to morbidity and mortality.
- Acute ischemic stroke (AIS) patients frequently exhibit elevated blood pressure (BP) upon presentation.
- Understanding the prognostic implications of BP in AIS is crucial for patient management.
Purpose of the Study:
- To investigate the association between emergency department (ED) systolic blood pressure (SBP) and stroke severity in AIS patients.
- To determine if SBP levels correlate with neurological deficit scores and patient disposition.
Main Methods:
- Observational study in an ED setting with a substantial annual patient census.
- Inclusion of adult patients presenting within 24 hours of AIS symptom onset.
- Measurement of BP at triage by a blinded nurse and assessment of stroke severity using the National Institutes of Health Stroke Scale (NIHSS).
Main Results:
- Higher SBP was significantly associated with lower NIHSS scores, indicating less severe strokes (p=0.0038).
- Elevated SBP correlated with increased likelihood of discharge home and decreased mortality or hospice admission.
- Diastolic blood pressure (DBP) did not show a significant association with stroke severity or patient outcomes.
Conclusions:
- In AIS patients presenting to the ED, higher SBP is linked to reduced stroke severity.
- Elevated SBP is associated with favorable outcomes, including home discharge and lower mortality.
- SBP may serve as a valuable prognostic marker in the acute management of ischemic stroke.
Context:
Stroke is one of the largest healthcare burdens in the United States and globally. It continues to be one of the leading causes of morbidity and mortality. Patients with acute ischemic stroke (AIS) often present with elevated blood pressure (BP).
Objectives:
The objective of our study was to evaluate the association of systolic blood pressure (SBP) in the emergency department (ED) with stroke severity in patients with AIS.
Methods:
This observational study was conducted at an ED with an annual census of 80,000 visits, approximately half (400) of which are for AIS. The cohort consisted of adult patients who presented to the ED within 24 h of stroke symptom onset. BP was measured at triage by a nurse blinded to the study. Stroke severity was measured utilizing the National Institutes of Health Stroke Scale (NIHSS). Statistical analyses were performed utilizing JMP 14.0. This study was approved by our medical school's institutional review board.
Results:
Patients with higher SBP had significantly lower NIHSS scores (p=0.0038). This association was significant even after adjusting for age and gender. By contrast, diastolic blood pressure (DBP) did not appear to impact stroke severity. There was no difference in the DBP values between men and women. Higher SBP was also significantly associated with being discharged home as well as being less likely to die in the hospital or discharged to hospice. The DBP did not demonstrate this association. Neither the SDP nor the DBP were significantly associated with the hospital length of stay (LOS). In multivariate models that included age, gender, basal metabolic index (BMI), comorbidities, and ED presentation, elevated SBP was associated with better prognosis.
Conclusions:
In this cohort of patients presenting with stroke-like symptoms to the ED, higher SBP was associated with lower stroke severity and higher rates of being discharged to home rather than hospice or death.
Related Concept Videos
01:17Measurement of Blood Pressure
01:30Hypertension III: Clinical Manifestations and Diagnostic Studies
01:28Special considerations while measuring blood pressure
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.
01:18Disorders of the Autonomic Nervous System
Raynaud's disease, also known as Raynaud's...
01:24Blood Pressure
01:28Factors affecting Blood pressure
Physiological Factors: