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Abstract
The predictive value of casual blood pressure (BP) levels following acute stroke on
outcome is currently unclear. This may in part reflect the observer bias and variability
of casual recordings, which are reduced with 24-hour recordings. We therefore proposed
to assess the prognostic significance of 24-hour compared to casual BP in predicting
30-day mortality, dependency and neurological outcome. A total of 136 consecutive
patients were assessed within 24 h of ictus by one observer, with casual and 24-hour
BP recording, and National Institutes of Health Stroke Scale and Modified Rankin Scale
scores. Repeat assessments were made at 7 and 30 days. Admission casual and 24-hour
systolic BP (SBP) and diastolic BP levels were significantly higher in patients with
poor outcome at 1 month following acute stroke, whether expressed in terms of mortality,
dependency or neurological deterioration, on single-variable logistic regression analysis.
However, of these variables, only admission 24-hour (not casual) SBP remained a significant
outcome predictor in a multiple model containing factors with an established association
with poor prognosis. The odds ratio for outcome of death or dependency associated
with each 10-mm-Hg increase in 24-hour SBP at admission was 1.88 (95% confidence interval:
1.27-2.78). For an outcome of death or high dependency, the model had a specificity
of 75% and sensitivity of 76% when tested by the jackknife technique. Therefore, increasing
24-hour BP levels following acute stroke predict poor outcome. Whether BP should be
reduced pharmacologically in the acute stroke period now warrants a suitable prospective
intervention trial.