Acute-Phase Blood Pressure Levels Correlate With a High Risk of Recurrent Strokes in Young-Onset Ischemic Stroke.

Satu Mustanoja Jukka Putaala Daniel Gordin Lauri Tulkki Karoliina Aarnio Jani Pirinen Ida Surakka Juha Sinisalo Mika Lehto Turgut Tatlisumak

Stroke

From the Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland (S.M., J. Putaala, L.T., K.A., J. Pirinen, T.T.); Abdominal Center Nephrology, Helsinki University Hospital, Folkhälsan Institute of Genetics at Folkhälsan Research Center, and Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland (D.G.); Department of Clinical Physiology and Nuclear Medicine, HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland (J. Pirinen, I.S.); Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland (J. Pirinen, J.S., M.L.); and Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.).

Published: June 2016

High blood pressure (BP) during the acute phase of ischemic stroke is linked to worse long-term outcomes, particularly among young adults aged 15 to 49, according to a study of 1004 patients.
The study found that higher admission BP measurements (systolic, diastolic, pulse pressure, and mean arterial pressure) were significantly associated with an increased risk of recurrent strokes over a median follow-up of 8.9 years.
Specifically, patients with systolic BP ≥160 mm Hg had a 3.3 times higher likelihood of experiencing a recurrent stroke compared to those with lower BP, indicating the importance of managing BP in young stroke patients.

Background And Purpose: High blood pressure (BP) in acute stroke has been associated with a poor outcome; however, this has not been evaluated in young adults.

Methods: The relationship between BP and long-term outcome was assessed in 1004 consecutive young, first-ever ischemic stroke patients aged 15 to 49 years enrolled in the Helsinki Young Stroke Registry. BP parameters included systolic (SBP) and diastolic BP, pulse pressure, and mean arterial pressure at admission and 24 hours. The primary outcome measure was recurrent stroke in the long-term follow-up. Adjusted for demographics and preexisting comorbidities, Cox regression models were used to assess independent BP parameters associated with outcome.

Results: Of our patients (63% male), 393 patients (39%) had prestroke hypertension and 358 (36%) used antihypertensive treatment. The median follow-up period was 8.9 years (interquartile range 5.7-13.2). Patients with a recurrent stroke (n=142, 14%) had significantly higher admission SBP, diastolic BP, pulse pressure, and mean arterial pressure (P<0.001) and 24-h SBP, diastolic BP, and mean arterial pressure compared with patients without the recurrent stroke. Patients with SBP ≥160 mm Hg compared with those with SBP <160 mm Hg had significantly more recurrent strokes (hazard ratio 3.3 [95% confidence interval, 2.05-4.55]; P<0.001) occurring earlier (13.9 years [13.0-14.6] versus 16.2 [15.8-16.6]; P<0.001) within the follow-up period. In multivariable analyses, higher admission SBP, diastolic BP, pulse pressure, and mean arterial pressure were independently associated with the risk of recurrent stroke, while the 24-hour BP levels were not.

Conclusions: In young ischemic stroke patients, high acute phase BP levels are independently associated with a high risk of recurrent strokes.

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http://dx.doi.org/10.1161/STROKEAHA.116.012944	DOI Listing

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