FACTORS AFFECTING CHANGES IN BLOOD-PRESSURE AFTER ACUTE STROKE

Background and Purpose We sought to establish the pattern of blood pre ssure (BP) change after hospitalization for acute hemispheric stroke. Methods In 292 patients from the Leicester teaching hospitals with acu te hemispheric stroke within the previous 24 hours (139 men; median ag e, 75 years [range, 42 to 98 years]), we prospectively studied BP chan ges between admission, 24 hours, 1 week, and 4 to 6 weeks. Changes wer e assessed in relation to the main stroke risk factors, stroke type an d severity, and antihypertensive drug treatment. All subjects were fol lowed up for 1 week, with 117 subjects followed up for 4 to 6 weeks. C hanges were assessed by repeated-measures ANOVA, and Student's t tests were used to compare group pairs. Results Systolic and diastolic BP f ell by 12 mm Hg (95% confidence interval [CI], 8 to 15 mm Hg) and 7 mm Hg (95% CI, 5 to 9 mm Hg), respectively, in the first 24 hours and 22 mm Hg (95% CI, 18 to 25 mm Hg) and 12 mm Hg (95% CI, 10 to 14 mm Hg), respectively, during the first week (all changes significant at P<.01 ) but no further thereafter. In those patients receiving no antihypert ensive medication before or after stroke, the pattern of change was si milar to that of the whole group. Previously diagnosed hypertensive su bjects (n=106) had higher initial BP values than did normotensive subj ects, although by 1 week the levels were not significantly different. Patients with cerebral hemorrhage confirmed by computed tomography (n= 20) had higher systolic BP, but not diastolic BP, throughout the first week than those with cerebral infarction (n=89). The severity of stro ke, age, and previous stroke history did not appear to alter the BP pa ttern. Stroke patients who were moderate to heavy alcohol consumers ha d lower convalescent systolic BP levels than lighter drinkers or absta iners. Conclusions We have demonstrated a marked fall in systolic and diastolic BP levels during the first 7 days after acute hemispheric st roke, with little change thereafter. Higher initial systolic BP values were found in patients with cerebral hemorrhage compared with those w ith cerebral infarct. Moderate to heavy alcohol consumption before str oke was associated with a greater systolic BP decline in the first wee k after the event compared with stroke patients who were light drinker s or abstainers.