Factors related to Blood Pressure Reduction during Acute Period of Ischemic Stroke

ABSTRACT

BACKGROUND: High blood pressure (BP) or BP reduction in acute ischemic stroke may be associated with poor outcomes. We investigated the factors associated with BP changes in acute ischemic stroke. METHODS: We examined consecutive ischemic stroke patients having symptom onset within 24 hours. We excluded patients with cardioembolism or stroke of other determined etiology. We assessed initial systolic/diastolic BP and the degree of BP reduction for 3 hospital days. We analyzed the following potential predictors age, sex, stroke risk factors, severity of neurologic deficits, infarct size, occlusive lesions in the main cerebral arteries, and antihypertensive medication use. RESULTS: 112 patients were evaluated. The initial systolic/diastolic BP was 153/90 mmHg and systolic/diastolic BP reduction was 22/8 mmHg. In multivariate analyses, initial systolic BPs were significantly higher in patients with hypertension (p=0.007), and were negatively associated with prior regular antihypertensive medication use (p=0.018). Initial high systolic and diastolic BPs were strong predictors of systolic and diastolic BP reduction, respectively (p<0.001 and p<0.001). Diabetes mellitus was also an independent predictor of systolic BP reduction (p=0.011). CONCLUSIONS: Initial high BP was significantly associated with high degree of BP reduction in acute ischemic stroke. Acute ischemic stroke patients with diabetes mellitus may show significant systolic BP reduction, which requires further confirmation.