Hypotension Makes for Poor Prognosis in Ischemic Stroke

This month in Journal Club, we continued our theme of prognostication papers as Corey reviewed two recent ones from Latha G. Stead’s group at Mayo.  One paper ran last year and is called “Initial Emergency Department Blood Pressure as Predictor of Survival After Acute Ischemic Stroke” (Neurology 2005, 65:1179:1183). The second paper is called “Impact of Acute Blood Pressure Variability on Ischemic Stroke Outcome” (Neurology 2006:66:1878-1881).

This is something I frankly hadn’t spent much time thinking about — all the emphasis in stroke guidelines and tPA admin has been about getting BP down into a safe range, not worrying about whose BP is too low. But the big result from the first paper was that a diastolic of < 70 mmHg, a systolic less than 155, or an MAP of less than 100 mmHg was associated with higher mortality at 90 days than those with higher BPs (even after adjusting for age, gender, NIHSS score, etc). The worst relative risk (RR) was for a diastolic less than 70; RR = 2.2 in that case, which the authors find is actually worse than the RR of having a diastolic over 105 (RR=1.9… How about that).