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Sare GM, Bath PM, Gray LJ, Moulin T, Woimant F, England T, Geeganage C, Christensen H, De Deyn PP, Leys D, O'Neill D, Ringelstein EB. The Relationship Between Baseline Blood Pressure and Computed Tomography Findings in Acute Stroke. Stroke 2009; 40:41-6. [DOI: 10.1161/strokeaha.108.526665] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
High blood pressure (BP) is present in ≈80% of patients with acute ischemic stroke and is independently associated with poor outcome. There are few data examining the relationship between admission BP and acute CT findings.
Methods—
TAIST was a randomized controlled trial assessing 10 days of treatment with tinzaparin versus aspirin in 1489 patients with acute ischemic stroke (<48 hr) with admission BP of ≤220/120 mmHg. CT brain scans were performed before randomization and after 10 days. The relationships between baseline BP and adjudicated CT findings were assessed. Odds ratios per 10 mmHg change in BP were calculated.
Results—
Higher systolic BP (SBP) was associated with abnormal CT scans because of independent associations with chronic changes of leukoariosis (OR, 1.12; 95% CI, 1.05–1.17) and old infarction (OR, 1.12; 95% CI, 1.06–1.17) at baseline, and signs of visible infarction at day 10 (OR, 1.06; 95% CI, 1.00–1.13). A lower SBP was associated with signs of acute infarction (OR, 0.94; 95% CI, 0.89–0.99). Hemorrhagic transformation, dense middle cerebral artery sign, mass effect, and cerebral edema at day 10 were not independently associated with baseline BP.
Conclusion—
Although high baseline BP is independently associated with a poor outcome after stroke, this was not shown to be through an association with increased hemorrhagic transformation, cerebral edema, or mass effect; trial design may be suboptimal to detect this. Higher SBP is associated with visible infarction on day 10 scans. The influence of changing BP in acute stroke on CT findings is still to be ascertained.
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Affiliation(s)
- Gillian M. Sare
- From Institute of Neuroscience (G.M.S., P.M.W.B., L.J.G., T.E., C.G.), University of Nottingham, Nottingham, UK; Stroke Unit (T.M.), CHU Besancon, University of Franche-Comte, Besancon, France; Department of Neurology (F.W.), Lariboisiere University Hospital, France; Department of Neurology (H.C.), Bispebjerg Hospital, Copenhagen, Denmark; Department of Neurology (P.P.D.D.), A. Z. Middelheim, ZNA, University of Antwerp, Antwerpen, Belgium; Clinique Neurologique (D.L.), CHRU de Lille, Lille, France
| | - Philip M.W. Bath
- From Institute of Neuroscience (G.M.S., P.M.W.B., L.J.G., T.E., C.G.), University of Nottingham, Nottingham, UK; Stroke Unit (T.M.), CHU Besancon, University of Franche-Comte, Besancon, France; Department of Neurology (F.W.), Lariboisiere University Hospital, France; Department of Neurology (H.C.), Bispebjerg Hospital, Copenhagen, Denmark; Department of Neurology (P.P.D.D.), A. Z. Middelheim, ZNA, University of Antwerp, Antwerpen, Belgium; Clinique Neurologique (D.L.), CHRU de Lille, Lille, France
| | - Laura J. Gray
- From Institute of Neuroscience (G.M.S., P.M.W.B., L.J.G., T.E., C.G.), University of Nottingham, Nottingham, UK; Stroke Unit (T.M.), CHU Besancon, University of Franche-Comte, Besancon, France; Department of Neurology (F.W.), Lariboisiere University Hospital, France; Department of Neurology (H.C.), Bispebjerg Hospital, Copenhagen, Denmark; Department of Neurology (P.P.D.D.), A. Z. Middelheim, ZNA, University of Antwerp, Antwerpen, Belgium; Clinique Neurologique (D.L.), CHRU de Lille, Lille, France
| | - Thierry Moulin
- From Institute of Neuroscience (G.M.S., P.M.W.B., L.J.G., T.E., C.G.), University of Nottingham, Nottingham, UK; Stroke Unit (T.M.), CHU Besancon, University of Franche-Comte, Besancon, France; Department of Neurology (F.W.), Lariboisiere University Hospital, France; Department of Neurology (H.C.), Bispebjerg Hospital, Copenhagen, Denmark; Department of Neurology (P.P.D.D.), A. Z. Middelheim, ZNA, University of Antwerp, Antwerpen, Belgium; Clinique Neurologique (D.L.), CHRU de Lille, Lille, France
| | - France Woimant
- From Institute of Neuroscience (G.M.S., P.M.W.B., L.J.G., T.E., C.G.), University of Nottingham, Nottingham, UK; Stroke Unit (T.M.), CHU Besancon, University of Franche-Comte, Besancon, France; Department of Neurology (F.W.), Lariboisiere University Hospital, France; Department of Neurology (H.C.), Bispebjerg Hospital, Copenhagen, Denmark; Department of Neurology (P.P.D.D.), A. Z. Middelheim, ZNA, University of Antwerp, Antwerpen, Belgium; Clinique Neurologique (D.L.), CHRU de Lille, Lille, France
| | - Timothy England
- From Institute of Neuroscience (G.M.S., P.M.W.B., L.J.G., T.E., C.G.), University of Nottingham, Nottingham, UK; Stroke Unit (T.M.), CHU Besancon, University of Franche-Comte, Besancon, France; Department of Neurology (F.W.), Lariboisiere University Hospital, France; Department of Neurology (H.C.), Bispebjerg Hospital, Copenhagen, Denmark; Department of Neurology (P.P.D.D.), A. Z. Middelheim, ZNA, University of Antwerp, Antwerpen, Belgium; Clinique Neurologique (D.L.), CHRU de Lille, Lille, France
| | - Chamila Geeganage
- From Institute of Neuroscience (G.M.S., P.M.W.B., L.J.G., T.E., C.G.), University of Nottingham, Nottingham, UK; Stroke Unit (T.M.), CHU Besancon, University of Franche-Comte, Besancon, France; Department of Neurology (F.W.), Lariboisiere University Hospital, France; Department of Neurology (H.C.), Bispebjerg Hospital, Copenhagen, Denmark; Department of Neurology (P.P.D.D.), A. Z. Middelheim, ZNA, University of Antwerp, Antwerpen, Belgium; Clinique Neurologique (D.L.), CHRU de Lille, Lille, France
| | - Hanne Christensen
- From Institute of Neuroscience (G.M.S., P.M.W.B., L.J.G., T.E., C.G.), University of Nottingham, Nottingham, UK; Stroke Unit (T.M.), CHU Besancon, University of Franche-Comte, Besancon, France; Department of Neurology (F.W.), Lariboisiere University Hospital, France; Department of Neurology (H.C.), Bispebjerg Hospital, Copenhagen, Denmark; Department of Neurology (P.P.D.D.), A. Z. Middelheim, ZNA, University of Antwerp, Antwerpen, Belgium; Clinique Neurologique (D.L.), CHRU de Lille, Lille, France
| | - Peter Paul De Deyn
- From Institute of Neuroscience (G.M.S., P.M.W.B., L.J.G., T.E., C.G.), University of Nottingham, Nottingham, UK; Stroke Unit (T.M.), CHU Besancon, University of Franche-Comte, Besancon, France; Department of Neurology (F.W.), Lariboisiere University Hospital, France; Department of Neurology (H.C.), Bispebjerg Hospital, Copenhagen, Denmark; Department of Neurology (P.P.D.D.), A. Z. Middelheim, ZNA, University of Antwerp, Antwerpen, Belgium; Clinique Neurologique (D.L.), CHRU de Lille, Lille, France
| | - Didier Leys
- From Institute of Neuroscience (G.M.S., P.M.W.B., L.J.G., T.E., C.G.), University of Nottingham, Nottingham, UK; Stroke Unit (T.M.), CHU Besancon, University of Franche-Comte, Besancon, France; Department of Neurology (F.W.), Lariboisiere University Hospital, France; Department of Neurology (H.C.), Bispebjerg Hospital, Copenhagen, Denmark; Department of Neurology (P.P.D.D.), A. Z. Middelheim, ZNA, University of Antwerp, Antwerpen, Belgium; Clinique Neurologique (D.L.), CHRU de Lille, Lille, France
| | - Desmond O'Neill
- From Institute of Neuroscience (G.M.S., P.M.W.B., L.J.G., T.E., C.G.), University of Nottingham, Nottingham, UK; Stroke Unit (T.M.), CHU Besancon, University of Franche-Comte, Besancon, France; Department of Neurology (F.W.), Lariboisiere University Hospital, France; Department of Neurology (H.C.), Bispebjerg Hospital, Copenhagen, Denmark; Department of Neurology (P.P.D.D.), A. Z. Middelheim, ZNA, University of Antwerp, Antwerpen, Belgium; Clinique Neurologique (D.L.), CHRU de Lille, Lille, France
| | - E. Bernd Ringelstein
- From Institute of Neuroscience (G.M.S., P.M.W.B., L.J.G., T.E., C.G.), University of Nottingham, Nottingham, UK; Stroke Unit (T.M.), CHU Besancon, University of Franche-Comte, Besancon, France; Department of Neurology (F.W.), Lariboisiere University Hospital, France; Department of Neurology (H.C.), Bispebjerg Hospital, Copenhagen, Denmark; Department of Neurology (P.P.D.D.), A. Z. Middelheim, ZNA, University of Antwerp, Antwerpen, Belgium; Clinique Neurologique (D.L.), CHRU de Lille, Lille, France
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