Background: It is unknown what significance different initial Systolic Blood Pressure (SBP) values have for patients presenting with acute ischemic stroke (AIS). We investigated factors associated with admission SBP, including hemorrhagic transformation (HT) and discharge outcome.
Methods: This is a retrospective study of consecutive AIS patients presenting from April 2014 to March 2015. Demographic and clinical data were collected, including admission SBP divided into three tiers: <140, 140-165 and >165. Primary measure of outcome was in-hospital mortality.
Results: A total of 776 patients were included with mean age 64, 49.2% females and 36.5% Black Race. Most patients with Black Race, hypertension (HTN) and hyperlipidemia (HLD) had SBP between 140-165 and >165, whereas most patients with heart failure had lower SBP (<140) (Table 1). The median SPB was 123 (113-133) in the <140 group, 152 (146-158) in the 140-165 group, and 188 (177-201) in the >165 group. A similar number of patients amongst the three groups were on BP medications (63.5% vs. 69.3% vs. 64.1%), and there were no differences in proportion of HT (15.7% vs. 18.7% vs.12.6%). Although the proportion of patients treated with IV TPA were evenly distributed among tiers (14.4% vs. 13.6% vs. 15.7%), more patients with blood pressure <166 were treated with endovascular therapy (7.8% vs. 8.9% vs. 3.7%; p=0.0321). In comparison to SBP<140, SBP>165 was associated with lower odds of in-hospital mortality (OR 0.536, 95%CI 0.295-0.975, p=0.041). This was significant after adjusting for age and NIHSS (OR 0.431, 95%CI 0.193-0.962, p=0.0399).
Conclusions: Normal presenting SBP in patients with AIS was associated with in-hospital mortality. This may be related to heart failure. Further research is needed to define the ideal range to maintain SBP after AIS.