U-shaped relationship between mortality and admission blood pressure in patients with acute stroke

K. N. Vemmos, Georgios Tsivgoulis, K. Spengos, N. Zakopoulos, A. Synetos, E. Manios, P. Konstantopoulou, M. Mavrikakis

Research output: Contribution to journalArticle

209 Citations (Scopus)

Abstract

Objective. To evaluate the relationship between systolic blood pressure (SBP) or diastolic blood pressure (DBP) on admission and early or late mortality in patients with acute stroke. Design. Prospective study of hospitalized first-ever stroke patients over 8 years. Setting. Stroke unit and medical wards in a University hospital. Subjects. A total of 1121 patients admitted within 24 h from stroke onset and followed up for 12 months. Main outcome measures. Mortality at 1 and 12 months after stroke in relation to admission SBP and DBP. Results. Early and late mortality in patients with acute ischaemic or haemorrhagic stroke in relation to admission SBP and DBP followed a 'U-curve pattern'. After adjusting for known outcome predictors, the relative risk of 1-month and 1-year mortality associated with a 10-mmHg SBP increase above 130 mmHg (U-point of the curve) increased by 10.2% (95% CI: 4.2-16.6%) and 7.2% (95% CI: 2.2-12.3%), respectively. For every 10 mmHg SBP decrease, below the U-point, the relative risk of 1-month and 1-year mortality rose by 28.2% (95% CI: 8.6-51.3%) and 17.5% (95% CI: 3.1-34.0%), respectively. Low admission SBP-values were associated with heart failure (P < 0.001) and coronary artery disease (P = 0.006), whilst high values were associated with history of hypertension (P < 0.001) and lacunar stroke (P < 0.001). Death due to cerebral oedema was significantly (P = 0.005) more frequent in patients with high admission SBP-values. whereas death due to cardiovascular disease was more frequent (P = 0.004) in patients with low admission SBP-values. Conclusion. Acute ischaemic or haemorrhagic stroke patients with high and low admission BP-values have a higher early and late mortality. Coincidence of heart disease is associated with low initial BP-values. Death due to neurological damage from brain oedema is associated with high initial BP-values.

Original languageEnglish (US)
Pages (from-to)257-265
Number of pages9
JournalJournal of Internal Medicine
Volume255
Issue number2
DOIs
StatePublished - Feb 1 2004

Fingerprint

Stroke
Blood Pressure
Mortality
Brain Edema
Lacunar Stroke
Coronary Artery Disease
Heart Diseases

All Science Journal Classification (ASJC) codes

  • Internal Medicine

Cite this

U-shaped relationship between mortality and admission blood pressure in patients with acute stroke. / Vemmos, K. N.; Tsivgoulis, Georgios; Spengos, K.; Zakopoulos, N.; Synetos, A.; Manios, E.; Konstantopoulou, P.; Mavrikakis, M.

In: Journal of Internal Medicine, Vol. 255, No. 2, 01.02.2004, p. 257-265.

Research output: Contribution to journalArticle

Vemmos, KN, Tsivgoulis, G, Spengos, K, Zakopoulos, N, Synetos, A, Manios, E, Konstantopoulou, P & Mavrikakis, M 2004, 'U-shaped relationship between mortality and admission blood pressure in patients with acute stroke', Journal of Internal Medicine, vol. 255, no. 2, pp. 257-265. https://doi.org/10.1046/j.1365-2796.2003.01291.x
Vemmos, K. N. ; Tsivgoulis, Georgios ; Spengos, K. ; Zakopoulos, N. ; Synetos, A. ; Manios, E. ; Konstantopoulou, P. ; Mavrikakis, M. / U-shaped relationship between mortality and admission blood pressure in patients with acute stroke. In: Journal of Internal Medicine. 2004 ; Vol. 255, No. 2. pp. 257-265.
@article{be70f7eb4f3e49b397c56a0c2786cefe,
title = "U-shaped relationship between mortality and admission blood pressure in patients with acute stroke",
abstract = "Objective. To evaluate the relationship between systolic blood pressure (SBP) or diastolic blood pressure (DBP) on admission and early or late mortality in patients with acute stroke. Design. Prospective study of hospitalized first-ever stroke patients over 8 years. Setting. Stroke unit and medical wards in a University hospital. Subjects. A total of 1121 patients admitted within 24 h from stroke onset and followed up for 12 months. Main outcome measures. Mortality at 1 and 12 months after stroke in relation to admission SBP and DBP. Results. Early and late mortality in patients with acute ischaemic or haemorrhagic stroke in relation to admission SBP and DBP followed a 'U-curve pattern'. After adjusting for known outcome predictors, the relative risk of 1-month and 1-year mortality associated with a 10-mmHg SBP increase above 130 mmHg (U-point of the curve) increased by 10.2{\%} (95{\%} CI: 4.2-16.6{\%}) and 7.2{\%} (95{\%} CI: 2.2-12.3{\%}), respectively. For every 10 mmHg SBP decrease, below the U-point, the relative risk of 1-month and 1-year mortality rose by 28.2{\%} (95{\%} CI: 8.6-51.3{\%}) and 17.5{\%} (95{\%} CI: 3.1-34.0{\%}), respectively. Low admission SBP-values were associated with heart failure (P < 0.001) and coronary artery disease (P = 0.006), whilst high values were associated with history of hypertension (P < 0.001) and lacunar stroke (P < 0.001). Death due to cerebral oedema was significantly (P = 0.005) more frequent in patients with high admission SBP-values. whereas death due to cardiovascular disease was more frequent (P = 0.004) in patients with low admission SBP-values. Conclusion. Acute ischaemic or haemorrhagic stroke patients with high and low admission BP-values have a higher early and late mortality. Coincidence of heart disease is associated with low initial BP-values. Death due to neurological damage from brain oedema is associated with high initial BP-values.",
author = "Vemmos, {K. N.} and Georgios Tsivgoulis and K. Spengos and N. Zakopoulos and A. Synetos and E. Manios and P. Konstantopoulou and M. Mavrikakis",
year = "2004",
month = "2",
day = "1",
doi = "10.1046/j.1365-2796.2003.01291.x",
language = "English (US)",
volume = "255",
pages = "257--265",
journal = "Journal of Internal Medicine",
issn = "0954-6820",
publisher = "Wiley-Blackwell",
number = "2",

}

TY - JOUR

T1 - U-shaped relationship between mortality and admission blood pressure in patients with acute stroke

AU - Vemmos, K. N.

AU - Tsivgoulis, Georgios

AU - Spengos, K.

AU - Zakopoulos, N.

AU - Synetos, A.

AU - Manios, E.

AU - Konstantopoulou, P.

AU - Mavrikakis, M.

PY - 2004/2/1

Y1 - 2004/2/1

N2 - Objective. To evaluate the relationship between systolic blood pressure (SBP) or diastolic blood pressure (DBP) on admission and early or late mortality in patients with acute stroke. Design. Prospective study of hospitalized first-ever stroke patients over 8 years. Setting. Stroke unit and medical wards in a University hospital. Subjects. A total of 1121 patients admitted within 24 h from stroke onset and followed up for 12 months. Main outcome measures. Mortality at 1 and 12 months after stroke in relation to admission SBP and DBP. Results. Early and late mortality in patients with acute ischaemic or haemorrhagic stroke in relation to admission SBP and DBP followed a 'U-curve pattern'. After adjusting for known outcome predictors, the relative risk of 1-month and 1-year mortality associated with a 10-mmHg SBP increase above 130 mmHg (U-point of the curve) increased by 10.2% (95% CI: 4.2-16.6%) and 7.2% (95% CI: 2.2-12.3%), respectively. For every 10 mmHg SBP decrease, below the U-point, the relative risk of 1-month and 1-year mortality rose by 28.2% (95% CI: 8.6-51.3%) and 17.5% (95% CI: 3.1-34.0%), respectively. Low admission SBP-values were associated with heart failure (P < 0.001) and coronary artery disease (P = 0.006), whilst high values were associated with history of hypertension (P < 0.001) and lacunar stroke (P < 0.001). Death due to cerebral oedema was significantly (P = 0.005) more frequent in patients with high admission SBP-values. whereas death due to cardiovascular disease was more frequent (P = 0.004) in patients with low admission SBP-values. Conclusion. Acute ischaemic or haemorrhagic stroke patients with high and low admission BP-values have a higher early and late mortality. Coincidence of heart disease is associated with low initial BP-values. Death due to neurological damage from brain oedema is associated with high initial BP-values.

AB - Objective. To evaluate the relationship between systolic blood pressure (SBP) or diastolic blood pressure (DBP) on admission and early or late mortality in patients with acute stroke. Design. Prospective study of hospitalized first-ever stroke patients over 8 years. Setting. Stroke unit and medical wards in a University hospital. Subjects. A total of 1121 patients admitted within 24 h from stroke onset and followed up for 12 months. Main outcome measures. Mortality at 1 and 12 months after stroke in relation to admission SBP and DBP. Results. Early and late mortality in patients with acute ischaemic or haemorrhagic stroke in relation to admission SBP and DBP followed a 'U-curve pattern'. After adjusting for known outcome predictors, the relative risk of 1-month and 1-year mortality associated with a 10-mmHg SBP increase above 130 mmHg (U-point of the curve) increased by 10.2% (95% CI: 4.2-16.6%) and 7.2% (95% CI: 2.2-12.3%), respectively. For every 10 mmHg SBP decrease, below the U-point, the relative risk of 1-month and 1-year mortality rose by 28.2% (95% CI: 8.6-51.3%) and 17.5% (95% CI: 3.1-34.0%), respectively. Low admission SBP-values were associated with heart failure (P < 0.001) and coronary artery disease (P = 0.006), whilst high values were associated with history of hypertension (P < 0.001) and lacunar stroke (P < 0.001). Death due to cerebral oedema was significantly (P = 0.005) more frequent in patients with high admission SBP-values. whereas death due to cardiovascular disease was more frequent (P = 0.004) in patients with low admission SBP-values. Conclusion. Acute ischaemic or haemorrhagic stroke patients with high and low admission BP-values have a higher early and late mortality. Coincidence of heart disease is associated with low initial BP-values. Death due to neurological damage from brain oedema is associated with high initial BP-values.

UR - http://www.scopus.com/inward/record.url?scp=1242317781&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=1242317781&partnerID=8YFLogxK

U2 - 10.1046/j.1365-2796.2003.01291.x

DO - 10.1046/j.1365-2796.2003.01291.x

M3 - Article

VL - 255

SP - 257

EP - 265

JO - Journal of Internal Medicine

JF - Journal of Internal Medicine

SN - 0954-6820

IS - 2

ER -