Blood pressure and in-hospital outcomes in patients presenting with ischaemic stroke

Sripal Bangalore, Lee Schwamm, Eric E. Smith, Anne S. Hellkamp, Robert E Suter, Ying Xian, Phillip J. Schulte, Gregg C. Fonarow, Deepak L. Bhatt

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Aims Post-stroke hypertension is associated with poor short-term outcome, although the results have been conflicting. Our objective was to evaluate the association of blood pressure (BP) and in-hospital outcomes in patients with acute ischaemic stroke. Methods and results Patients in the Get With The Guidelines-Stroke registry with acute ischaemic stroke were included. Admission systolic and diastolic BP was used to compute mean arterial pressure (MAP) and pulse pressure (PP). The outcomes of interest were: in-hospital mortality, not discharged home, inability to ambulate independently at discharge and haemorrhagic complications due to thrombolytic therapy. A total of 309 611 patients with an ischaemic stroke were included. There was a J-shaped/U-shaped relationship between systolic BP and outcomes. Both lower and higher systolic BP values, compared with a central reference value, had higher risk of in-hospital death [e.g. adjusted odds ratio (95% confidence interval) (OR[CI])= 1.16[1.13-1.20] for 120 vs. 150mmHg and 1.24[1.19-1.30] for 200 vs. 150mmHg], not discharged home (OR[CI]=1.11[1.09-1.13] for 120 vs. 150mmHg and 1.15[1.12-1.18] for 200 vs. 150mmHg), inability to ambulate independently at discharge (OR[CI]= 1.16[1.13-1.18] for 120 vs. 150mmHg and 1.09[1.06-1.11] for 200 vs. 150mmHg). However, risk of haemorrhagic complications of thrombolytic therapy was lower with lower systolic BP (OR[CI]= 0.89[0.83-0.97] for 120 vs. 150mmHg), while higher with higher systolic BP (OR[CI]= 1.21[1.11-1.32] for 200 vs. 150 mmHg). The results were largely similar for admission diastolic BP, MAP, and PP. Conclusion In patients hospitalized with ischaemic stroke, J-shaped, or U-shaped relationships were observed between BP variables and short-term outcomes. However, haemorrhagic complications with thrombolytic therapy were lower with lower BP.

Original languageEnglish (US)
Pages (from-to)2827-2835
Number of pages9
JournalEuropean Heart Journal
Volume38
Issue number37
DOIs
StatePublished - Oct 1 2017

Fingerprint

Stroke
Blood Pressure
Thrombolytic Therapy
Hypertension
Arterial Pressure
Hospital Mortality
Registries
Reference Values
Odds Ratio
Guidelines
Confidence Intervals

Keywords

  • Blood pressure
  • Diastolic
  • Ischaemic stroke
  • Mean arterial pressure
  • Pulse pressure
  • Stroke
  • Systolic
  • Transient ischaemic attack

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Bangalore, S., Schwamm, L., Smith, E. E., Hellkamp, A. S., Suter, R. E., Xian, Y., ... Bhatt, D. L. (2017). Blood pressure and in-hospital outcomes in patients presenting with ischaemic stroke. European Heart Journal, 38(37), 2827-2835. https://doi.org/10.1093/eurheartj/ehx330

Blood pressure and in-hospital outcomes in patients presenting with ischaemic stroke. / Bangalore, Sripal; Schwamm, Lee; Smith, Eric E.; Hellkamp, Anne S.; Suter, Robert E; Xian, Ying; Schulte, Phillip J.; Fonarow, Gregg C.; Bhatt, Deepak L.

In: European Heart Journal, Vol. 38, No. 37, 01.10.2017, p. 2827-2835.

Research output: Contribution to journalArticle

Bangalore, S, Schwamm, L, Smith, EE, Hellkamp, AS, Suter, RE, Xian, Y, Schulte, PJ, Fonarow, GC & Bhatt, DL 2017, 'Blood pressure and in-hospital outcomes in patients presenting with ischaemic stroke', European Heart Journal, vol. 38, no. 37, pp. 2827-2835. https://doi.org/10.1093/eurheartj/ehx330
Bangalore, Sripal ; Schwamm, Lee ; Smith, Eric E. ; Hellkamp, Anne S. ; Suter, Robert E ; Xian, Ying ; Schulte, Phillip J. ; Fonarow, Gregg C. ; Bhatt, Deepak L. / Blood pressure and in-hospital outcomes in patients presenting with ischaemic stroke. In: European Heart Journal. 2017 ; Vol. 38, No. 37. pp. 2827-2835.
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abstract = "Aims Post-stroke hypertension is associated with poor short-term outcome, although the results have been conflicting. Our objective was to evaluate the association of blood pressure (BP) and in-hospital outcomes in patients with acute ischaemic stroke. Methods and results Patients in the Get With The Guidelines-Stroke registry with acute ischaemic stroke were included. Admission systolic and diastolic BP was used to compute mean arterial pressure (MAP) and pulse pressure (PP). The outcomes of interest were: in-hospital mortality, not discharged home, inability to ambulate independently at discharge and haemorrhagic complications due to thrombolytic therapy. A total of 309 611 patients with an ischaemic stroke were included. There was a J-shaped/U-shaped relationship between systolic BP and outcomes. Both lower and higher systolic BP values, compared with a central reference value, had higher risk of in-hospital death [e.g. adjusted odds ratio (95{\%} confidence interval) (OR[CI])= 1.16[1.13-1.20] for 120 vs. 150mmHg and 1.24[1.19-1.30] for 200 vs. 150mmHg], not discharged home (OR[CI]=1.11[1.09-1.13] for 120 vs. 150mmHg and 1.15[1.12-1.18] for 200 vs. 150mmHg), inability to ambulate independently at discharge (OR[CI]= 1.16[1.13-1.18] for 120 vs. 150mmHg and 1.09[1.06-1.11] for 200 vs. 150mmHg). However, risk of haemorrhagic complications of thrombolytic therapy was lower with lower systolic BP (OR[CI]= 0.89[0.83-0.97] for 120 vs. 150mmHg), while higher with higher systolic BP (OR[CI]= 1.21[1.11-1.32] for 200 vs. 150 mmHg). The results were largely similar for admission diastolic BP, MAP, and PP. Conclusion In patients hospitalized with ischaemic stroke, J-shaped, or U-shaped relationships were observed between BP variables and short-term outcomes. However, haemorrhagic complications with thrombolytic therapy were lower with lower BP.",
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AU - Bangalore, Sripal

AU - Schwamm, Lee

AU - Smith, Eric E.

AU - Hellkamp, Anne S.

AU - Suter, Robert E

AU - Xian, Ying

AU - Schulte, Phillip J.

AU - Fonarow, Gregg C.

AU - Bhatt, Deepak L.

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N2 - Aims Post-stroke hypertension is associated with poor short-term outcome, although the results have been conflicting. Our objective was to evaluate the association of blood pressure (BP) and in-hospital outcomes in patients with acute ischaemic stroke. Methods and results Patients in the Get With The Guidelines-Stroke registry with acute ischaemic stroke were included. Admission systolic and diastolic BP was used to compute mean arterial pressure (MAP) and pulse pressure (PP). The outcomes of interest were: in-hospital mortality, not discharged home, inability to ambulate independently at discharge and haemorrhagic complications due to thrombolytic therapy. A total of 309 611 patients with an ischaemic stroke were included. There was a J-shaped/U-shaped relationship between systolic BP and outcomes. Both lower and higher systolic BP values, compared with a central reference value, had higher risk of in-hospital death [e.g. adjusted odds ratio (95% confidence interval) (OR[CI])= 1.16[1.13-1.20] for 120 vs. 150mmHg and 1.24[1.19-1.30] for 200 vs. 150mmHg], not discharged home (OR[CI]=1.11[1.09-1.13] for 120 vs. 150mmHg and 1.15[1.12-1.18] for 200 vs. 150mmHg), inability to ambulate independently at discharge (OR[CI]= 1.16[1.13-1.18] for 120 vs. 150mmHg and 1.09[1.06-1.11] for 200 vs. 150mmHg). However, risk of haemorrhagic complications of thrombolytic therapy was lower with lower systolic BP (OR[CI]= 0.89[0.83-0.97] for 120 vs. 150mmHg), while higher with higher systolic BP (OR[CI]= 1.21[1.11-1.32] for 200 vs. 150 mmHg). The results were largely similar for admission diastolic BP, MAP, and PP. Conclusion In patients hospitalized with ischaemic stroke, J-shaped, or U-shaped relationships were observed between BP variables and short-term outcomes. However, haemorrhagic complications with thrombolytic therapy were lower with lower BP.

AB - Aims Post-stroke hypertension is associated with poor short-term outcome, although the results have been conflicting. Our objective was to evaluate the association of blood pressure (BP) and in-hospital outcomes in patients with acute ischaemic stroke. Methods and results Patients in the Get With The Guidelines-Stroke registry with acute ischaemic stroke were included. Admission systolic and diastolic BP was used to compute mean arterial pressure (MAP) and pulse pressure (PP). The outcomes of interest were: in-hospital mortality, not discharged home, inability to ambulate independently at discharge and haemorrhagic complications due to thrombolytic therapy. A total of 309 611 patients with an ischaemic stroke were included. There was a J-shaped/U-shaped relationship between systolic BP and outcomes. Both lower and higher systolic BP values, compared with a central reference value, had higher risk of in-hospital death [e.g. adjusted odds ratio (95% confidence interval) (OR[CI])= 1.16[1.13-1.20] for 120 vs. 150mmHg and 1.24[1.19-1.30] for 200 vs. 150mmHg], not discharged home (OR[CI]=1.11[1.09-1.13] for 120 vs. 150mmHg and 1.15[1.12-1.18] for 200 vs. 150mmHg), inability to ambulate independently at discharge (OR[CI]= 1.16[1.13-1.18] for 120 vs. 150mmHg and 1.09[1.06-1.11] for 200 vs. 150mmHg). However, risk of haemorrhagic complications of thrombolytic therapy was lower with lower systolic BP (OR[CI]= 0.89[0.83-0.97] for 120 vs. 150mmHg), while higher with higher systolic BP (OR[CI]= 1.21[1.11-1.32] for 200 vs. 150 mmHg). The results were largely similar for admission diastolic BP, MAP, and PP. Conclusion In patients hospitalized with ischaemic stroke, J-shaped, or U-shaped relationships were observed between BP variables and short-term outcomes. However, haemorrhagic complications with thrombolytic therapy were lower with lower BP.

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KW - Mean arterial pressure

KW - Pulse pressure

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KW - Systolic

KW - Transient ischaemic attack

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