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      The Predictive Role of 24-Hour Compared to Casual Blood Pressure Levels on Outcome following Acute Stroke

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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.

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          Author and article information

          Journal
          CED
          Cerebrovasc Dis
          10.1159/issn.1015-9770
          Cerebrovascular Diseases
          S. Karger AG
          1015-9770
          1421-9786
          1997
          1997
          15 September 1997
          : 7
          : 5
          : 264-272
          Affiliations
          a University Division of Medicine for the Elderly, The Glenfield Hospital, and b University Department of Epidemiology and Public Health, Leicester, UK
          Article
          108206 Cerebrovasc Dis 1997;7:264–272
          10.1159/000108206
          d1240cca-60bf-42a5-9121-af7c1ae577f4
          © 1997 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          History
          Page count
          Pages: 9
          Categories
          Original Paper

          Geriatric medicine,Neurology,Cardiovascular Medicine,Neurosciences,Clinical Psychology & Psychiatry,Public health
          Blood pressure,Cerebrovascular disease,Prognosis

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