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Headache as a Predictive Factor of Severe Systolic Hypertension in Acute Ischemic Stroke

Published online by Cambridge University Press:  02 December 2014

Yoon-Ho Hong ,
Yong-Seok Lee  and
Seong-Ho Park
Yoon-Ho Hong
Affiliation:
Department of Neurology, Seoul Municipal Boramae Hospital and College of Medicine, Seoul National University, Seoul, Korea
Yong-Seok Lee
Affiliation:
Department of Neurology, Seoul Municipal Boramae Hospital and College of Medicine, Seoul National University, Seoul, Korea
Seong-Ho Park
Affiliation:
Department of Neurology, Seoul Municipal Boramae Hospital and College of Medicine, Seoul National University, Seoul, Korea
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Abstract:

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Background:

Elevation of blood pressure (BP) is common in acute cerebral infarction, with several studies reporting a high plasma catecholamine level or previous hypertension as a contributory factor. However, more comprehensive studies on associated clinical parameters are lacking. Our main aim in undertaking this study was to correlate clinical variables associated with a BPelevation in acute ischemic stroke.

Methods:

Consecutive patients who were admitted to the emergency room and diagnosed with an acute cerebral infarction within 24 hours after the onset of symptoms were investigated. A BP elevation was defined as a high systolic (³200mmHg) or diastolic (³110 mmHg) pressure. The mean systolic and diastolic BP were compared between the different stroke subtypes, lesion locations (carotid vs. vertebrobasilar), and hemispheric sides. The frequency of symptoms, risk factors, location of the infarct, stroke severity, vascular status and laboratory abnormalities were analyzed in order to build a regression model.

Results:

One hundred thirty-one patients were recruited (M:F=60:71, mean age 66±12 years) and an elevated BP was identified in 33 patients (25.2%). The mean systolic and diastolic BP did not differ significantly between the stroke subtypes, lesion locations, and hemispheric sides. According to univariate logistic regression, an elevated systolic BP correlated with headache (p=0.01) and underlying hypertension (p=0.02) while an elevated diastolic BP correlated with underlying hypertension (p=0.01). Multivariate logistic regression analysis revealed previous hypertension (OR 5.21, 95% CI 1.40-19.37) and headache (OR 4.09, 95% CI 1.44-11.66) to be independent predictors of an elevated systolic BP.

Conclusions:

Headache itself is closely associated with severe systolic BP elevation in acute ischemic stroke. Whether treatment of elevated BP improves headache and clinical outcome is not yet known, necessitating future controlled studies.

Résumé:

RÉSUMÉ: Introduction:

Il est fréquent d’observer une tension artérielle (TA) élevée dans l’infarctus cérébral aigu et plusieurs études rapportent un niveau élevé de catécholamines plasmatiqus ou une hypertension préexistante comme facteur contributif. Cependant, il n’existe pas d’études plus exhaustives sur les paramètres cliniques qui y sont associés. Le but principal de cette étude était d’établir des corrélations entre des variables cliniques et une élévation de la TAdans l’accident vasculaire cérébral (AVC) ischémique.

Méthodes:

Une série de patients admis consécutivement à l’urgence et chez qui on a posé un diagnostic d’infarctus cérébral aigu dans les 24 heures du début des symptômes ont été évalués. Une TAélevée était définie comme suit: une tension systolique 3 200 mmHg ou diastolique 3 110 mmHg. Les tensions systolique et diastolique moyenne ont été comparées entre les différents sous-types d’AVC, le site des lésions (territoire carotidien et vertébro-basilaire) et l’hémisphère droit et gauche. La fréquence des symptômes, les facteurs de risque, le site de l’infarctus, la sévérité de l’AVC, le statut vasculaire et les anomalies de laboratoire ont été analysés afin d’établir un modèle de régression.

Résultats:

Cent trente et un patients ont été recrutés, 60 hommes et 71 femmes, dont l’âge moyen était de 66 ± 12 ans. Une TAélevée a été observée chez 33 patients (25,2%). Les TAsystolique et diastolique n’étaient pas significativement différentes selon le sous-type d’AVC, le site de la lésion et l’hémisphère touché. L’analyse de régression univariée a montré qu’il existait une corrélation entre une TA systolique élevée et la céphalée (p = 0,01) et une hypertension sous-jacente (p = 0,01). L’analyse de régression multivariée a montré que l’hypertension préexistante (RR 5,21; IC 95% 1,40-19,37) et la céphalée (RR 4,09; IC 95% 1,44-11,66) étaient des facteurs prédisant une TAsystolique élevée.

Conclusions:

La céphalée est étroitement associée à une TA systolique très élevée dans l’AVC ischémique aigu. Il faudrait réaliser des études contrôlées, car on ne sait pas encore si le traitement de l’hypertension améliore la céphalée et l’évolution clinique.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 30 , Issue 3 , August 2003 , pp. 210 - 214
Copyright
Copyright © The Canadian Journal of Neurological 2003

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