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(Hypertension. 2009;54:769.)
© 2009 American Heart Association, Inc.

Original Articles

Age Determines the Effects of Blood Pressure Lowering During the Acute Phase of Ischemic Stroke

The TICA Study

Rogelio Leira; Mónica Millán; Exuperio Díez-Tejedor; Miguel Blanco; Joaquín Serena; Blanca Fuentes; Manuel Rodríguez-Yáñez; Mar Castellanos; Aida Lago; Antonio Dávalos; José Castillo for the TICA Study, Stroke Project, Cerebrovascular Diseases Group of the Spanish Neurological Society

From the Department of Neurology (R.L., M.B., M.R.-Y., J.C.), Hospital Clínico Universitario, Universidad de Santiago de Compostela, Santiago de Compostela, Spain; Department of Neurosciences (M.M., A.D.), Hospital Universitario Germans Trias i Pujol, Universidad Autónoma de Barcelona, Barcelona, Spain; Department of Neurology (E.D.-T., B.F.), Hospital Universitario de la Paz, Universidad Autónoma de Madrid, Madrid, Spain; Department of Neurology (J.S., M.C.), Hospital Universitario Doctor Josep Trueta, Gerona, Spain; Department of Neurology (A.L.), Hospital Universitario la Fe, Valencia, Spain.

Correspondence to José Castillo, Servicio de Neurología, Hospital Clínico Universitario, c/o Travesa da Choupana, s/n, 15706 Santiago de Compostela, Spain. E-mail jose.castillo{at}usc.es

To increase understanding of the influence of blood pressure (BP) changes on functional outcome, we designed a multicenter, prospective, observational study involving patients with ischemic stroke. We included 1092 patients with ischemic stroke. BP was measured on admission and after 8, 16, 24, 32, 40, and 48 hours, and the averages of the readings were taken every 8 hours on days 3 to 7, at the day of discharge, and at 3 months. The main study variable was modified Rankin scale at 3 months. Systolic BPs >181 mm Hg at the emergency department and after 24 hours were associated with poor prognosis (odds ratio [OR]: 2.2, 95% CI: 1.2 to 4.2 and OR: 1.3, 95% CI: 1.1 to 2.3, respectively); systolic BP <136 mm Hg at the emergency department also determined worse prognosis at 3 months (OR: 1.3; 95% CI: 1.1 to 2.9). The influence of systolic BP changes in the first hours depended on patient age. In elder patients (>70 years), reductions in systolic BP determined a significant increase in the proportion of patients with worse prognosis. In patients >80 years of age, decreases in systolic BP >27.2 mm Hg determined a worse prognosis in patients with antihypertensive treatment at the emergency department (n=91) compared with those who did not receive treatment (n=106; OR: 21.7, 95% CI: 13.6 to 33.5 versus OR: 8.5, 95% CI: 3.2 to 19.6). In summary, the effect of BP modification during the acute phase of ischemic stroke on functional outcome is strongly dependent on age.

Key Words: ischemic stroke • blood pressure • age • prognosis • treatment

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