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Systolic blood pressure as a predictor of transient ischemic attack/minor stroke in emergency department patients under age 80: a prospective cohort study.
Penn, Andrew M; Croteau, Nicole S; Votova, Kristine; Sedgwick, Colin; Balshaw, Robert F; Coutts, Shelagh B; Penn, Melanie; Blackwood, Kaitlin; Bibok, Maximilian B; Saly, Viera; Hegedus, Janka; Yu, Amy Y X; Zerna, Charlotte; Klourfeld, Evgenia; Lesperance, Mary L.
Afiliación
  • Penn AM; Stroke Rapid Assessment Unit, Island Health, Victoria, BC, Canada.
  • Croteau NS; Department of Research and Capacity Building, Island Health, 1952 Bay Street, Victoria, BC, V8R1J8, Canada.
  • Votova K; Department of Mathematics and Statistics, University of Victoria, Victoria, BC, Canada.
  • Sedgwick C; Department of Research and Capacity Building, Island Health, 1952 Bay Street, Victoria, BC, V8R1J8, Canada. Kristine.Votova@viha.ca.
  • Balshaw RF; Division of Medical Sciences, University of Victoria, Victoria, BC, Canada. Kristine.Votova@viha.ca.
  • Coutts SB; Division of Medical Sciences, University of Victoria, Victoria, BC, Canada.
  • Penn M; George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada.
  • Blackwood K; Departments of Clinical Neurosciences, Radiology, and Community Health Services, Hotchkiss Brain Institute, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada.
  • Bibok MB; Stroke Rapid Assessment Unit, Island Health, Victoria, BC, Canada.
  • Saly V; Department of Research and Capacity Building, Island Health, 1952 Bay Street, Victoria, BC, V8R1J8, Canada.
  • Hegedus J; Department of Research and Capacity Building, Island Health, 1952 Bay Street, Victoria, BC, V8R1J8, Canada.
  • Yu AYX; Stroke Rapid Assessment Unit, Island Health, Victoria, BC, Canada.
  • Zerna C; Stroke Rapid Assessment Unit, Island Health, Victoria, BC, Canada.
  • Klourfeld E; Departments of Clinical Neurosciences, Radiology, and Community Health Services, Hotchkiss Brain Institute, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada.
  • Lesperance ML; Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
BMC Neurol ; 19(1): 251, 2019 Oct 25.
Article en En | MEDLINE | ID: mdl-31653207
BACKGROUND: Elevated blood pressure (BP) at emergency department (ED) presentation and advancing age have been associated with risk of ischemic stroke; however, the relationship between BP, age, and transient ischemic attack/minor stroke (TIA/MS) is not clear. METHODS: A multi-site, prospective, observational study of 1084 ED patients screened for suspected TIA/MS (symptom onset < 24 h, NIHSS< 4) between December 2013 and April 2016. Systolic and diastolic BP measurements (SBP, DBP) were taken at ED presentation. Final diagnosis was consensus adjudication by stroke neurologists; patients were diagnosed as either TIA/MS or stroke-mimic (non-cerebrovascular conditions). Conditional inference trees were used to define age cut-points for predicting binary diagnosis (TIA/MS or stroke-mimic). Logistic regression models were used to estimate the effect of BP, age, sex, and the age-BP interaction on predicting TIA/MS diagnosis. RESULTS: Over a 28-month period, 768 (71%) patients were diagnosed with TIA/MS: these patients were older (mean 71.6 years) and more likely to be male (58%) than stroke-mimics (61.4 years, 41%; each p < 0.001). TIA/MS patients had higher SBP than stroke-mimics (p < 0.001). DBP did not differ between the two groups (p = 0.191). SBP was predictive of TIA/MS diagnosis in younger patients, after accounting for age and sex; an increase of 10 mmHg systolic increased the odds of TIA/MS 18% (odds ratio [OR] 1.18, 95% CI 1.00-1.39) in patients < 60 years, and 23% (OR 1.23, 95% CI 11.12-1.35) in those 60-79 years, while not affecting the odds of TIA/MS in patients ≥80 years (OR 0.99, 95% CI 0.89-1.07). CONCLUSIONS: Raised SBP in patients younger than 80 with suspected TIA/MS may be a useful clinical indicator upon initial presentation to help increase clinicians' suspicion of TIA/MS. TRIAL REGISTRATION: ClinicalTrials.gov NCT03050099 (10-Feb-2017) and NCT03070067 (3-Mar-2017). Retrospectively registered.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Presión Sanguínea / Ataque Isquémico Transitorio / Accidente Cerebrovascular / Hipertensión Tipo de estudio: Clinical_trials / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: BMC Neurol Asunto de la revista: NEUROLOGIA Año: 2019 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Presión Sanguínea / Ataque Isquémico Transitorio / Accidente Cerebrovascular / Hipertensión Tipo de estudio: Clinical_trials / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: BMC Neurol Asunto de la revista: NEUROLOGIA Año: 2019 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Reino Unido