Trends in admission blood pressure and stroke outcome in patients with acute stroke and transient ischemic attack in a National Acute Stroke registry

Objective: Elevated blood pressure (BP) is common during an acute stroke and is associated with unfavorable outcome. Management of hypertension has improved in recent years. We aimed to evaluate trends in admission BP levels in patients admitted with acute stroke and transient ischemic attack (TIA) over the past decade. Methods: Data were based on the National Acute Stroke Israeli Registry. The study population comprised 6177 patients, aged at least18 years admitted for acute stroke (4382 ischemic stroke and 476 intracerebral hemorrhage) or TIA (1227) and had data on BP levels on admission. We studied temporal trends in admission BP and preadmission antihypertensive therapy from 2004 to 2010. Results: Admission SBP (mean ± SD) in patients with acute stroke decreased from 161 ± 29 mmHg in 2004 to 153 ± 28 mmHg in 2010 (P < 0.001). Similar trends were observed for patients with TIA. The use of three or more antihypertensive agents before stroke onset increased from 16.9% in 2004 to 20.0% in 2010 (P = 0.02). In patients with acute stroke, higher admission SBP was associated with increased stroke severity (P < 0.001). Rate of disability at discharge or in-hospital death decreased from 71.3% in 2004 to 64.8% in 2010 (P < 0.0001). Admission SBP was associated with disability at discharge or in-hospital death with an adjusted odds ratio (95% confidence interval) of 1.06 (1.04-1.08) per 10 mmHg change in SBP. Conclusion: Admission SBP in patients with acute stroke and TIA decreased from 2004 to 2010 and may have contributed to the improved outcome in these patients.