M. Rodríguez-Yáñez, MD, PhD, M. Castellanos, MD, PhD, M. Blanco, MD, PhD, M. M. García, PhD, F. Nombela, MD, PhD, J. Serena, MD, PhD, R. Leira, MD, PhD, I. Lizasoain, MD, PhD, A. Dávalos, MD, PhD and J. Castillo, MD, PhD
From the Department of Neurology, Stroke Unit, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain (M.R.-Y., M.B., R.L., J.C.); Department of Neurology, Stroke Unit (M.C., J.S.), and Unit of Biostatistics, Hospital Doctor Josep Trueta, Girona, Spain (M.M.G.); Department of Neurology, Stroke Unit (F.N.), Hospital de la Princesa, Madrid, Spain; Department of Pharmacology, School of Medicine, University Complutense, Madrid, Spain (I.L.); and Department of Neurology, Stroke Unit, Hospital Trias i Pujol, Barcelona, Spain (A.D.).
Objective: To study the association of previously unknown high blood pressure (HBP) during the acute phase of stroke (new-onset hypertension) with the inflammatory response and clinical outcome.
Methods: We classified 844 patients with hemispheric ischemic stroke into three groups according to history of hypertension and presence of HBP within the first 24 hours after symptom onset: Group I (n = 412), normotensive patients; Group II (n = 265), chronic hypertensive patients; and Group III (n = 167), new-onset hypertensive patients. Interleukin 6 (IL-6), tumor necrosis factor (TNF- ), intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1), and metalloproteinase 9 (MMP-9) were measured in blood samples obtained on admission. The influence of new-onset HBP and markers of inflammation on poor neurologic outcome at 3 months was evaluated by logistic regression analysis.
Results: New-onset HBP was found in 19.9% of patients. Patients in this group had higher plasma concentrations of IL-6, TNF- , ICAM-1, VCAM-1, and MMP-9 than the other two groups. New-onset HBP was associated with poor outcome at 3 months (odds ratio [OR] 2.10; 95% CI 1.54 to 3.52; p < 0.0001) after adjustment for other prognostic factors. However, when markers of inflammation were included in the model, IL-6 (OR 1.01; 95% CI 1.00 to 1.03; p = 0.020) and MMP-9 (OR 1.01; 95% CI 1.00 to 1.01; p < 0.0001), but not new-onset HBP, were independently associated with poor neurologic outcome.
Conclusions: New-onset high blood pressure in acute ischemic stroke, but not chronic hypertension, is associated with an inflammatory response and poor neurologic outcome. Full Text
NEUROLOGY 2006;67:1973-1978
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