Low BP is poor prognostic factor in acute stroke

Takeaway

• Patients with acute ischaemic stroke having low systolic BP (SBP) at first measurement in the emergency department had elevated risks for in-hospital mortality and complications.

Why this matters

• Importance of greater vigilance for these complications in this subgroup.

Key results

• Vs counterparts with normal SBP (≥10th percentile but <185 mmHg), patients with low SBP (<10th percentile; <130 mmHg) had increased risks for:
  • In-hospital mortality (8.0% vs 4.2%; aOR, 1.58; 95% CI, 1.13-2.21).
  • Complications (16.0% vs 6.5%; aOR, 2.56; 95% CI, 1.60-4.10).
• Individual complications:
  • Heart failure (2.4% vs 0.1%; aOR, 17.85; 95% CI, 3.36-94.86).
  • Gastrointestinal bleeding (1.9% vs 0.1%; aOR, 26.04; 95% CI, 2.83-239.30).
  • Sepsis (3.3% vs 0.5%; aOR, 5.53; 95% CI, 1.84-16.67).

Study design

• Post-hoc analysis of 2124 patients with acute ischaemic stroke from Dutch randomised trial (PASS study).
• Main outcomes: in-hospital mortality, major complications <7 days after stroke onset, functional outcome (modified Rankin scale score).
• Funding: Netherlands Organization for Health Research and Development; others.

Limitations

• Lack of clearly defined cut-off for low SBP, serial SBP measurements.
• Aortic, carotid dissections causing low SBP possibly missed.
• Unknown generalisability.