Stroke, Vol 25, 1726-1729, Copyright © 1994 by American Heart Association
G Harper, CM Castleden and JF Potter
BACKGROUND AND PURPOSE: We sought to establish the pattern of blood
pressure (BP) change after hospitalization for acute hemispheric stroke.
METHODS: In 292 patients from the Leicester teaching hospitals with acute
hemispheric stroke within the previous 24 hours (139 men; median age, 75
years [range, 42 to 98 years]), we prospectively studied BP changes between
admission, 24 hours, 1 week, and 4 to 6 weeks. Changes were assessed in
relation to the main stroke risk factors, stroke type and severity, and
antihypertensive drug treatment. All subjects were followed up for 1 week,
with 117 subjects followed up for 4 to 6 weeks. Changes were assessed by
repeated-measures ANOVA, and Student's t tests were used to compare group
pairs. RESULTS: Systolic and diastolic BP fell by 12 mm Hg (95% confidence
interval [CI], 8 to 15 mm Hg) and 7 mm Hg (95% CI, 5 to 9 mm Hg),
respectively, in the first 24 hours and 22 mm Hg (95% CI, 18 to 25 mm Hg)
and 12 mm Hg (95% CI, 10 to 14 mm Hg), respectively, during the first week
(all changes significant at P < .01) but no further thereafter. In those
patients receiving no antihypertensive medication before or after stroke,
the pattern of change was similar to that of the whole group. Previously
diagnosed hypertensive subjects (n = 106) had higher initial BP values than
did normotensive subjects, although by 1 week the levels were not
significantly different. Patients with cerebral hemorrhage confirmed by
computed tomography (n = 20) had higher systolic BP, but not diastolic BP,
throughout the first week than those with cerebral infarction (n = 89). The
severity of stroke, age, and previous stroke history did not appear to
alter the BP pattern. Stroke patients who were moderate to heavy alcohol
consumers had lower convalescent systolic BP levels than lighter drinkers
or abstainers. CONCLUSIONS: We have demonstrated a marked fall in systolic
and diastolic BP levels during the first 7 days after acute hemispheric
stroke, with little change thereafter. Higher initial systolic BP values
were found in patients with cerebral hemorrhage compared with those with
cerebral infarct. Moderate to heavy alcohol consumption before stroke was
associated with a greater systolic BP decline in the first week after the
event compared with stroke patients who were light drinkers or abstainers.
ARTICLES
Factors affecting changes in blood pressure after acute stroke
University Department of Medicine for the Elderly, Leicester General Hospital, UK.
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