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

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) = 1.161.13-1.20 for 120 vs. 150 mmHg and 1.241.19-1.30 for 200 vs. 150 mmHg], not discharged home (ORCI = 1.111.09-1.13 for 120 vs. 150 mmHg and 1.151.12-1.18 for 200 vs. 150 mmHg), inability to ambulate independently at discharge (ORCI = 1.161.13-1.18 for 120 vs. 150 mmHg and 1.091.06-1.11 for 200 vs. 150 mmHg). However, risk of haemorrhagic complications of thrombolytic therapy was lower with lower systolic BP (ORCI = 0.890.83-0.97 for 120 vs. 150 mmHg), while higher with higher systolic BP (ORCI = 1.211.11-1.32 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.