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(Stroke. 2008;39:366.)
© 2008 American Heart Association, Inc.

Original Contributions

Association of Characteristics of Blood Pressure Profiles and Stroke Outcomes in the ECASS-II Trial

From the Department of Statistics in Medicine (M.Y.), Heinrich Heine University Hospital, Duesseldorf, Germany; and the Department of Neurology (M.K.), Helsinki University Central Hospital, Helsinki, Finland.

Correspondence to Mei Yong, PhD, MSc (Epi), Department of Statistics in Medicine, Heinrich Heine University Hospital, University Street 1, PO Box 101007, D-40001 Duesseldorf, Germany. E-mail yong{at}uni-duesseldorf.de

Background and Purpose— Certain characteristics of early blood pressure (BP) profiles were reported to be independent predictors of long-term outcome in the first European Cooperative Acute Stroke Study (ECASS-I) trial. The aim of the study was to find out the association of BP profiles with functional outcome, mortality, and hemorrhagic complications in the ECASS-II database.

Methods— We studied 793 patients with acute ischemic hemispheric stroke in the ECASS-II. After randomization, BP was measured every 15 minutes during the first 2 hours, then every 30 minutes during the first 8 hours, and thereafter at 1-hour intervals up to 24 hours. Individual 0- to 24-hour BP profiles were characterized by baseline, maximum, minimum, and mean BP and successive variation of the profile. The end points were favorable outcome (modified Rankin Scale score of 0 or 1) at day 90, all-cause mortality at day 90, and hemorrhagic transformation within the first 7 days.

Results— High baseline, maximum, mean level, and variability of systolic BP profiles were each inversely associated with favorable outcome (OR=0.84, 95% CI: 0.74 to 0.94; OR=0.82, 95% CI: 0.73 to 0.91; OR=0.81, 95% CI: 0.71 to 0.93; OR=0.57, 95% CI: 0.35 to 0.92, respectively) and associated with an increased risk of parenchymal hemorrhage within the first 7 days (OR=1.27, 95% CI: 1.07 to 1.51; OR=1.49, 95% CI: 1.27 to 1.75; OR=1.52, 95% CI: 1.23 to 1.87; OR=2.62, 95% CI: 1.40 to 4.87; respectively) in recombinant tissue plasminogen activator-treated patients. In placebo-treated patients, high maximum, mean level, and successive variation of systolic BP profiles were inversely associated with favorable outcome (OR=0.76, 95% CI: 0.66 to 0.86; OR=0.76, 95% CI: 0.65 to 0.89; OR=0.41, 95% CI: 0.22 to 0.76; respectively), although the association of baseline systolic BP and favorable outcome was not significant (OR=0.91, 95% CI: 0.80 to 1.03). No association with hemorrhagic transformation was found, even after the adjustment.

Conclusions— The hemorrhagic transformation within the first 7 days and favorable outcome were independently associated with dynamics of BP within the first 24 hours after an acute ischemic stroke in patients treated with thrombolysis, but in placebo-treated patients, only with favorable outcome. Continuous BP monitoring is hence important for the prognosis and gives implications to optimize BP management, particularly regarding a reasonable BP level and stability.

Key Words: blood pressure • ischemic stroke • outcome • prediction • recombinant tissue plasminogen activator