The impact of blood pressure hemodynamics in acute ischemic stroke: a prospective cohort study

The study cohort consisted of 189 patients who presented to our emergency department with ischemic stroke of less than 24 hours onset who had hemodynamic parameters recorded and available for review. Blood pressure (BP) was non-invasively measured at 5 minute intervals for the length of the patient's emergency department stay. Systolic BP (sBP) and diastolic BP (dBP) were measured for each patient and a differential (the maximum minus the minimum BP) calculated. Three outcomes were studied: stroke severity, disability at hospital discharge, and death at 90 days. Statistical tests used included Spearman correlations (for stroke severity), Wilcoxon test (for disability) and Cox models (for death).Larger differentials of either dBP (p = 0.003) or sBP (p < 0.001) were significantly associated with more severe strokes. A greater dBP (p = 0.019) or sBP (p = 0.036) differential was associated with a significantly worse functional outcome at hospital discharge. Those patients with larger differentials of either dBP (p = 0.008) or sBP (0.007) were also significantly more likely to be dead at 90 days, independently of the basal BP.A large differential in either systolic or diastolic blood pressure within 24 hours of symptom onset in acute ischemic stroke appears to be associated with more severe strokes, worse functional outcome and early deathStroke is associated with a high mortality and significant long-term functional disability. Of the 15 million patients affected by stroke worldwide yearly, the World Health Organization reports almost a third of these patients die, and another third are permanently disabled. Hypertension accounts for nearly 12.7 million strokes worldwide [1].Close to 80% of acute ischemic stroke (AIS) patients have an elevated blood pressure [2]. The elevation of blood pressure (BP) post-AIS has a multitude of causes, ranging from chronic hypertension and sympathetic stress response to stroke-related pathology itself [3]. Previous studies have shown tha