Key result
An increase of 10 mmHg in systolic blood pressure at emergency department presentation increased the odds of a transient ischemic attack or minor stroke diagnosis by 23% in patients aged 60 to 79 years.
Why the study?
Elevated blood pressure and advancing age are linked to ischemic stroke risk, but their relationship with transient ischemic attack or minor stroke is unclear.
Does elevated systolic blood pressure predict TIA/minor stroke diagnosis in emergency department patients under age 80?
Cohort (n=1,084)
Yes
Does elevated systolic blood pressure predict TIA/minor stroke diagnosis in emergency department patients under age 80?
Elevated systolic blood pressure at emergency department presentation is a significant predictor of TIA/minor stroke in patients under 80 years of age, which may aid clinicians in early triage and diagnosis.
SBP at ED presentation may aid triage under age 80; extends age-specific associations but leaves open prospective validation.
BACKGROUND: Elevated blood pressure (BP) at emergency department (ED) presentation and advancing age have been associated with risk of ischemic stroke; however, the relationship between BP, age, and transient ischemic attack/minor stroke (TIA/MS) is not clear. METHODS: A multi-site, prospective, observational study of 1084 ED patients screened for suspected TIA/MS (symptom onset < 24 h, NIHSS< 4) between December 2013 and April 2016. Systolic and diastolic BP measurements (SBP, DBP) were taken at ED presentation. Final diagnosis was consensus adjudication by stroke neurologists; patients were diagnosed as either TIA/MS or stroke-mimic (non-cerebrovascular conditions). Conditional inference trees were used to define age cut-points for predicting binary diagnosis (TIA/MS or stroke-mimic). Logistic regression models were used to estimate the effect of BP, age, sex, and the age-BP interaction on predicting TIA/MS diagnosis. RESULTS: Over a 28-month period, 768 (71%) patients were diagnosed with TIA/MS: these patients were older (mean 71.6 years) and more likely to be male (58%) than stroke-mimics (61.4 years, 41%; each p < 0.001). TIA/MS patients had higher SBP than stroke-mimics (p < 0.001). DBP did not differ between the two groups (p = 0.191). SBP was predictive of TIA/MS diagnosis in younger patients, after accounting for age and sex; an increase of 10 mmHg systolic increased the odds of TIA/MS 18% (odds ratio [OR] 1.18, 95% CI 1.00-1.39) in patients < 60 years, and 23% (OR 1.23, 95% CI 11.12-1.35) in those 60-79 years, while not affecting the odds of TIA/MS in patients ≥80 years (OR 0.99, 95% CI 0.89-1.07). CONCLUSIONS: Raised SBP in patients younger than 80 with suspected TIA/MS may be a useful clinical indicator upon initial presentation to help increase clinicians' suspicion of TIA/MS. TRIAL REGISTRATION: ClinicalTrials.gov NCT03050099 (10-Feb-2017) and NCT03070067 (3-Mar-2017). Retrospectively registered.
No takes yet. Share an insight, caveat, or question.
Penn et al. (2019) conducted a cohort in Suspected transient ischemic attack or minor stroke (n=1,084). Elevated systolic blood pressure vs. Lower systolic blood pressure was evaluated on Diagnosis of TIA/minor stroke vs stroke-mimic (OR 1.23, 95% CI 1.12-1.35, p=<0.001). An increase of 10 mmHg in systolic blood pressure at emergency department presentation increased the odds of a transient ischemic attack or minor stroke diagnosis by 23% in patients aged 60 to 79 years.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: