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 Schulte, Gregg C. Fonarow, Deepak L. Bhatt

Research output: Contribution to journalArticle

10 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
Externally publishedYes

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; 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, P, 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 S, Schwamm L, Smith EE, Hellkamp AS, Suter RE, Xian Y et al. Blood pressure and in-hospital outcomes in patients presenting with ischaemic stroke. European Heart Journal. 2017 Oct 1;38(37):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 ; 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 - Smith, Eric E.

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AU - Suter, Robert E.

AU - Xian, Ying

AU - Schulte, Phillip

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

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