Blood Pressure Variability and Outcome in Ischemic Stroke Patients

Blood Pressure Variability and Outcome in Ischemic Stroke Patients

Jocelyn Owusu-Yaw PharmD Candidate, Jody L. Rocker PharmD, Jeffrey A. Switzer D.O., David C. Hess M.D., Susan C. Fagan PharmD. Abstract

Purpose: In the acute stroke setting, high blood pressure variability has been associated with poor outcome. However, the relationship to antihypertensive medication is less clear. The American Stroke Association has no clear blood pressure target in the acute stroke setting. Blood pressure lowering medication is often reinstituted 24 hours after the patient presents with an ischemic stroke. This study is aimed at examining the relationship between blood pressure variability over the first 3 days after stroke and patient disposition.

Methods: This retrospective study included all patients admitted to the stroke service with ischemic stroke symptoms in the period of between January and June 2010. Blood pressures were recorded from the time of admission through the first 3 days of hospital stay. Patients were assigned good disposition based on a discharge home, or poor disposition based on discharge to an inpatient rehabilitation or nursing center.  

Results: Of the 82 patients enrolled, 28% had a poor disposition and 72 % had a good disposition. The definition of high variability in systolic blood pressure (SBP) was a change of ≥ 40 mmHg within one day. In a preliminary review, it appears that the patients with low variability had a better chance of a good disposition. The average number of BP lowering medications for good and poor outcome patients was 1.87 and 1.92 respectively. Analysis is ongoing.

Conclusion: Low BP variability in the first 3 days of hospital admission for ischemic stroke appears to be associated with good outcome. Further analysis is needed to determine the role of BP lowering medications and outcome.