THE PREDICTIVE ROLE OF 24-HOUR COMPARED TO CASUAL BLOOD-PRESSURE LEVELS ON OUTCOME FOLLOWING ACUTE STROKE

The predictive value of casual blood pressure (BP) levels following ac ute stroke on outcome is currently unclear. This may in part reflect t he observer bias and variability of casual recordings, which are reduc ed with 24-hour recordings. We therefore proposed to assess the progno stic significance of 24-hour compared to casual BP in predicting 30-da y mortality, dependency and neurological outcome. A total of 136 conse cutive patients were assessed within 24 h of ictus by one observer, wi th 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 (SEP) and diastolic BP levels were significantly higher in patients with po or outcome at 1 month following acute stroke, whether expressed in ter ms of mortality, dependency or neurological deterioration, on single-v ariable logistic regression analysis. However, of these variables, onl y admission 24-hour (not casual) SEP remained a significant outcome pr edictor in a multiple model containing factors with an established ass ociation with poor prognosis. The odds ratio for outcome of death or d ependency associated with each 10-mm-Hg increase in 24-hour SEP at adm ission was 1.88 (95% confidence interval: 1.27-2.78). For an outcome o f death or high dependency, the model had a specificity of 75% and sen sitivity of 76% when tested by the jackknife technique. Therefore, inc reasing 24-hour BP levels following acute stroke predict poor outcome. Whether BP should be reduced pharmacologically in the acute stroke pe riod now warrants a suitable prospective intervention trial.