Acute blood pressure levels and neurological deterioration in different subtypes of ischemic stroke

Background and Purpose - The purpose of this study was to determine at which time points acute blood pressure (BP) was associated with neurological deterioration at 3 weeks in patients with ischemic stroke as a whole and in patients with different subtypes. Methods - BP was measured every 6 hours for the first 36 hours of emergent hospitalization in 565 consecutive patients (347 men, 70 ± 11 years in age) presenting within 24 hours of an acute ischemic stroke. Neurological deterioration was defined as a ≥2-point increase in the National Institutes of Health stroke scale (NIHSS) score at 3 weeks compared to the admission score. Results - At 3 weeks, 64 patients (11.3%) had deteriorated neurologically. For the group as a whole, high systolic BP (SBP) values measured at 12, 18, 24, and 36 hours postadmission were independently related to neurological deterioration after adjustment for age, sex, and known predictors, including admission NIHSS score, admission blood glucose level, and large infarct size. At 24 hours, the odds of neurological deterioration increased by 20% per 10-mm Hg increase in SBP. For cardioembolic stroke patients, high SBP values measured at 12 through 36 hours were independently related to neurological deterioration after multivariate adjustment. For patients having stroke other than cardioembolism, no SBP values at any time point were related to neurological deterioration. Conclusions - Acute SBP values between 12 and 36 hours postadmission, but not those on admission or at 6 hours, were predictive of neurological deterioration within the initial 3 weeks of ischemic stroke, particularly for cardioembolic stroke patients.