J-shaped relationship between mortality and admission blood pressure in black patients with acute stroke.

AIM: The charts of 388 patients admitted for a recent stroke at the University of Kinshasa Hospital, Department of Medicine, were analysed to assess the case fatality rate and its determinants. RESULTS: During the hospitalization period (average 31 days), 169 deaths (44%) were recorded. Mortality was higher (P<0.05) in women (54%) than in men (42%), in haemorrhagic (61%) than in ischaemic (26%) strokes, and in patients with depressed consciousness, motor deficits, tachycardia or atrial fibrillation on admission. Mortality increased with advancing age, the depth of coma, the severity of motor deficit and the plasma glucose level on admission. Plasma glucose, urea and the leucocyte count were higher in patients who died than in survivors. Patients with and without a history of hypertension, diabetes or stroke recurrence had similar mortality rates. The latter tended to be higher in smokers and alcohol consumers. Using logistic regression analysis, depressed consciousness (P<0.001), tachycardia (P<0.001), plasma urea on admission (P<0.05) and a history of alcohol consumption (P<0.05) emerged as significant predictors of mortality. Admission systolic/diastolic blood pressure was similar in those who died (177 +/- 41/104 +/- 26 mmHg) and in survivors (171 +/- 41/101 +/- 23 mmHg). However, in the whole study population and in subgroups of patients who were comatose or conscious on admission, mortality showed a J-shaped relationship to admission systolic blood pressure with low rates in the range 160-199 mmHg before and after adjustment for age and sex, higher rates being observed for higher or lower blood pressure ranges. CONCLUSIONS: Depressed consciousness, ECG abnormalities, delayed admission and elevated plasma urea predict a high case fatality rate whereas systolic blood pressure within the range 160-199 mmHg appears to be optimal for survival in the patient group studied.

[Initial arterial pressure and prognosis of cerebrovascular accidents]. / Pression artérielle initiale et pronostic de l'accident vasculaire cérébral.

The present study analysed the charts of the patients admitted for acute stroke and assessed the relation between stroke mortality and initial blood pressure. Of the 388 patients admitted, 169 (44%) died. Mortality increased with advancing age and was higher in women, in hemorrhagic stroke (61%), and in patients with severe neurological deficit on admission. Average blood pressure on admission did not differ between the patients who died and those who survived. However, mortality was 42, 32, 57 and 62% in patients whose admission systolic blood pressure was, respectively, less than 160 mmHg, 160 to 199 mmHg, 200 to 249 mmHg and 250 mmHg or more. It described a similar curve when four categories of admission diastolic blood pressure were constituted. The data indicate a high case fatality rate in stroke patients. Mortality was higher in women; it increased with age and severe neurological deficit. The relation of stroke mortality to admission blood pressure suggests that it is not the lowest in patients with the lowest blood pressure, but in those with blood pressure level allowing the best brain perfusion after the onset of stroke.

The efficacy of beta-adrenoceptor and calcium-entry blockers in hypertensive blacks.

The data on treatment of hypertension in black patients with beta-adrenoceptor blockers (BB) or calcium-entry blockers (CEB) have been reviewed. There is much evidence that in monotherapy BB are no better than inert placebo for the majority of hypertensive black patients. Their hypotensive action in blacks is less than that induced by other antihypertensive agents, mainly diuretics. Comparative evaluation of the responsiveness of blacks, whites, and Indians to BB therapy showed a poorer control of blood pressure (BP) among blacks than among nonblacks. However, when combined with diuretic therapy, BBs are equipotent in blacks and whites. The reasons for the hyporesponsiveness of black patients to BB therapy are not fully understood. On the other hand, CEBs appear to be as efficacious as diuretic therapy in hypertensive blacks. In addition, they lower blood pressure to the same extent in black and white patients. They are also proven to be effective adjunctive therapy to diuretics for hypertension in blacks. The reason for the better responsiveness of blacks to CEB therapy might include the severity of hypertension in blacks, their low plasma renin, their blunted sympathetic activity, and their high intracellular sodium concentration.