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

Objective To assess the effects of acute blood pressure (BP) on long-term mortality following stroke. Design Prospective observational study. Setting Leicester Teaching Hospitals. Patients Two hundred and nineteen consecutive patients were recruited within 24 h of acute stroke. Interventions 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. Main outcome measures 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. Results On multiple variable analysis, 24 h systolic BP (greater than or equal to 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 less than or equal to 66 years. Conclusions 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. J Hypertens 19:2127-2134 (C) 2001 Lippincott Williams & Wilkins.