We studied the relationship of blood pressure (BP) trajectories during the first seven days after symptom onset with short- and long-term major clinical outcomes among patients with acute ischemic stroke. A total of 4,036 patients with acute ischemic stroke and elevated systolic BP from the CATIS trial were included in this analysis. Three BPs were measured every 2 hours for the first 24 hours, every 4 hours during the second and third days, and every 8 hours thereafter for the remainder of the seven days. Latent class models were used to identify subgroups that share a similar underlying trajectory in BP in the acute phase. Five systolic BP trajectories of high, high-to-moderate low, moderate high, moderate low, and low were identified. Compared to the high trajectory, multiple-adjusted odds ratios (95% CI) of death and major disability at 3 months for high-to-moderate low, moderate high, moderate low, and low trajectories were 0.61 (0.44 to 0.86), 0.63 (0.48 to 0.84), 0.49 (0.37 to 0.65), and 0.42 (0.30 to 0.59), respectively (overall p<0.0001). Likewise, the corresponding multiple-adjusted odds ratios at 2 years were 0.64 (0.46 to 0.90), 0.78 (0.59 to 1.04), 0.49 (0.37 to 0.66), and 0.49 (0.34 to 0.69), respectively (overall p<0.0001). These data indicate that individuals with a consistently high systolic BP during the acute phase of ischemic stroke had the highest risk of short- and long-term death and major disability. In addition, moderate systolic BP reduction to below 140 mmHg from higher levels lowers risk of short- and long-term death and major disability.
Acute Ischemic Stroke and New Anticoagulants How to Act in the Acute Phase of Stroke