ystolic Blood Pressure During Acute Stroke is Associated With Functional Status and Long-term Mortality in the Elderly. Stroke. 2013
“Let the blood pressure rise”…might be a frequent say among specialists treating patients with an acute stroke. The AHA guidelines for treatment of acute stroke advices caution on treating high blood pressure in this setting. Some clinical trials and observational studies have even suggested that a rapid decline or aggressive lowering of blood pressure might be associated with worse outcomes. In this issue of Stroke, Grossman et al. present data in regards to predictors of short and long term functional status and mortality in an elderly population with acute stroke that challenges the notion that high blood pressure might be protective in the acute stroke context.
The investigators recruited 177 patients > 70 years old with acute stroke and hypertension (excluding those with DBP/SBP > 120/220). They obtained baseline characteristics, mRs at 7 days and mortality at 5 years. Two key features of this study are original: the continuous blood pressure measurement over the first 24 hrs of the stroke and the long term follow. The investigators found that in the short term; average continuously-measured SBP > 160 (compared to manually obtain) predicted a worse outcome, and average SBP > 160 conferred greater odds of mortality compared to those with SBP < 160 after adjusting for covariates included in the model. Although this study doesn’t answer whether blood pressure should be let to freely rise in the setting of acute stroke or if it should be maintained within certain parameters, it brings up some additional interesting questions. For example, is elevated SBP in this elderly population an indicator of stroke severity or could it represent a marker of more advanced cardiovascular disease? Are the effects of increased SBP on functional outcome and mortality the same across different stroke mechanisms? what could be the mechanisms explaining the worse outcome 7 days after the index event vs. the 5-year mortality increment?