A Reasonable Blood Pressure Level for Good Clinical Outcome After the Acute Phase of Ischemic Stroke

Blood pressure (BP) levels are closely associated with clinical outcomes in patients with acute ischemic stroke, but current research data cannot yet determine what level of reasonable BP should be maintained in clinical practice. The authors conducted a prospective registered clinical trial and enrolled 873 patients admitted for the first episode of acute ischemic stroke within 24 hours from symptom onset and with normal neurological function before stroke. Analysis results showed that the highest probability of good neurological recovery was associated with the lowest risk of neurological deterioration and poor functional outcome at systolic BP (SBP) and diastolic BP (DBP) levels of 140 mm Hg to 159 mm Hg and DBP 90 mm Hg to 99 mm Hg, respectively, whereas patients with extreme hypotension (SBP <100 mm Hg /DBP <70 mm Hg) and hypertension (SBP ≥200 mm Hg /DBP ≥120 mm Hg) were associated with poor neurological recovery. Both higher and lower BP levels in the acute phase of ischemic stroke were unfavorable to neurological functional recovery (adjusted odds ratio, 1.948/1.913 and 2.129/2.022, respectively, with SBP 120-139 mm Hg as a reference). In addition, BP maintained at SBP 140 mm Hg to 159 mm Hg and DBP 90 mm Hg to 99 mm Hg within 7 days after stroke may be beneficial to neurological functional recovery.