Twenty-four hour systolic blood pressure predicts long-term mortality following acute stroke

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Abstract
To assess the effects of acute blood pressure (BP) on long-term mortality following stroke. Prospective observational study. Leicester Teaching Hospitals. Two hundred and nineteen consecutive patients were recruited within 24 h of acute stroke. Clinic and 24 h BP levels were measured. Other risk factors previously associated with stroke mortality were recorded within 24 h of admission. No specific pharmacological interventions ;were made. The primary outcome measure was death over a median follow-up period of over 2.5 years. The hazards ratios associated with predefined variables were assessed using Cox's proportional hazards modelling, and Kaplan–Meier survival plots were also calculated. On multiple variable analysis, 24 h systolic BP (≥ 160 mmHg) was associated with an increased hazards ratio of 2.41 (95% confidence intervals: 1.24–4.67) for death, compared to the reference group (140–159 mmHg). The addition of 24 h heart rate was significant, with increasing heart rate (> 83 bpm) associated with an increased mortality (P = 0.006), although this effect was not constant over time. Increasing age (> 80 years) at presentation was also associated with an increased hazards ratio of 2.53 (1.14–5.62) compared to age ≤ 66 years. This study provides evidence that elevated 24 h systolic BP 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.