To evaluate the association of blood pressure (BP) in the emergency department (ED) with ED stroke severity and discharge disposition in patients with acute ischemic stroke (AIS).

Close to 80% of AIS patients have an elevated BP. Some cohort studies have suggested that admission BP  prognosticates outcome after AIS whereas others conducted similarly have refuted the above result.

This was an IRB approved prospective observational quality registry study that included all adult patients who presented to the ED within 24 hours of stroke symptom onset. The BP was measured at triage by a nurse blinded to the study.  Stroke severity was measured using the National Institutes of Health Scale (NIHSS). Statistical analyses were performed using JMP 14.0 (Mac).

The cohort (n=653) was 37% was Hispanic, 16% Black, 43% White. 54% were male. The median age was 71 years (IQR 61-80). 29% had a history of prior stroke. The median systolic BP (sBP) was 157 mmHg (IQR 136-186).  The median NIHSS was 4, (IQR  1-11).  Patients with higher sBP had significantly lower NIHSS  (P=0.0044). This association was significant even after adjusting for age and gender.

By contrast, the diastolic BP did not appear to impact stroke severity. The median dBP was 82 mmHg( IQR 71-93). There was no difference in dBP values between men and women. The median pulse pressure (PP) was 83 (IQR 68-93). Neither the PP nor the dBP were significantly associated with stroke severity.

51% of the cohort was discharged home. Both higher sBP (P=0.0074) and dBP (0.0079)were significantly associated with being discharged home.

There appears to be a protective effect of blood pressure, where a higher sBP is associated with lower stroke severity and higher BP is associated with ultimately being discharged home. This reinforces the concept of permissive hypertension in the acute phase of ischemic stroke.