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Title: Elevated Systolic Pressure Indicates Long Term Mortality After Acute Stroke

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Journal of Hypertension 2001;19:2127-2134.
12/06/2001 10:17:01 AM
By Harvey McConnell

There is evidence that elevated 24-hour systolic blood pressure in the acute stroke period is associated with increased long-term mortality. "This may have implications in the therapeutic management of BP following stroke, though further research is required to determine the timing, nature and effect of such an intervention," declares Dr Thompson Robinson and colleagues at the Department of Medicine, Division of Medicine for the Elderly, Leicester Warwick Medical School, University of Leicester, Leicester, England. In their prospective observational study to assess the effects of acute blood pressure (BP) on long-term mortality following stroke, clinicians enrolled 219 consecutive patients within 24 hours of acute stroke. Blood pressure on admission and at 24 hours were measured. In addition, other risk factors previously associated with stroke mortality were recorded within 24 hours of admission. No specific pharmacological interventions;were made by the clinicians. Primary outcome measure was death over a median follow-up period of more than 2.5 years. The hazards ratios associated with predefined variables were assessed using Cox's proportional hazards modeling, and Kaplan-Meier survival plots were also calculated. Dr Robinson and colleagues found on multiple variable analysis, 24 hour systolic blood pressure ( 160 mmHg) was associated with an increased hazards ratio of 2.41 for death, compared to the reference group (140-159 mmHg). The addition of 24 hour heart rate was significant, with increasing heart rate (> 83 bpm) associated with an increased mortality, although this effect was not constant over time. Clinicians also found among the patients that increasing age (> 80 years) at presentation was also associated with an increased hazards ratio of 2.53 compared with patients who were age 66.

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