Blood Pressure in Acute Stroke: How Low Is Too Low?

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Blood Pressure in Acute Stroke: How Low Is Too Low?

In this study, BPs below about 155/70 mm Hg were associated with increased mortality in patients presenting with acute ischemic stroke.

Previous research has suggested that low blood pressure is detrimental in patients with acute ischemic stroke (Journal Watch Nov 28 2003). Current guidelines recommend antihypertensive drug treatment of acute stroke patients only when systolic BP exceeds 220 mm Hg or diastolic BP exceeds 120 mm Hg, unless other indications mandate treatment.

In this observational study, Mayo Clinic researchers examined associations between BP and mortality among 357 patients with acute ischemic stroke who presented to the emergency department (ED) within 24 hours of symptom onset. Severity of stroke at the time of presentation was recorded according to the NIH Stroke Scale.

Seventy-five patients died within 90 days. The optimal diastolic BP range on presentation to the ED was found to be 70 to 105 mm Hg. Among patients whose diastolic BP was lower than 70 mm Hg, there was a significant twofold increase in mortality, even after adjustment for severity of stroke on admission. For systolic BP, the optimal range was 155 to 220 mm Hg, and among patients with systolic BP below 155 mm Hg, mortality doubled, a significant difference. Trends toward increased mortality also were suggested for patients with diastolic or systolic BP above the optimal ranges, but statistical power was limited due to small numbers of patients in these categories.

Comment: In this study, initial BPs below about 155/70 mm Hg were associated with increased mortality in patients presenting with acute ischemic stroke. Because this association persisted after adjustment for severity of stroke, one might speculate that low BP itself contributed to mortality. The question of whether we should actively intervene to raise BP in such patients remains unsettled, however.

— Allan S. Brett, MD

Published in Journal Watch General Medicine November 8, 2005

Citation(s):

Stead LG et al. Initial emergency department blood pressure as predictor of survival after acute ischemic stroke. Neurology 2005 Oct 25; 65:1179-83.

Original article (Subscription may be required)
Medline abstract (Free)

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