Objective To assess the effects of acute blood pressure (BP) on long-term m
ortality following stroke.
Design Prospective observational study.
Setting Leicester Teaching Hospitals.
Patients Two hundred and nineteen consecutive patients were recruited withi
n 24 h of acute stroke.
Interventions Clinic and 24 h BP levels were measured. Other risk factors p
reviously associated with stroke mortality were recorded within 24 h of adm
ission. No specific pharmacological interventions;were made.
Main outcome measures The primary outcome measure was death over a median f
ollow-up period of over 2.5 years. The hazards ratios associated with prede
fined variables were assessed using Cox's proportional hazards modelling, a
nd Kaplan-Meier survival plots were also calculated.
Results On multiple variable analysis, 24 h systolic BP (greater than or eq
ual to 160 mmHg) was associated with an increased hazards ratio of 2.41 (95
% confidence intervals: 1.24-4.67) for death, compared to the reference gro
up (140-159 mmHg). The addition of 24 h heart rate was significant, with in
creasing heart rate (> 83 bpm) associated with an increased mortality (P =
0.006), although this effect was not constant over time. Increasing age (>
80 years) at presentation was also associated with an increased hazards rat
io of 2.53 (1.14-5.62) compared to age less than or equal to 66 years.
Conclusions This study provides evidence that elevated 24 h systolic BP in
the acute stroke period is associated with increased long-term mortality. T
his may have implications in the therapeutic management of BP following str
oke, though further research is required to determine the timing, nature an
d effect of such an intervention. J Hypertens 19:2127-2134 (C) 2001 Lippinc
ott Williams & Wilkins.