Systolic blood pressure as a predictor of transient ischemic attack/minor stroke in emergency department patients under age 80: a prospective cohort study

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dc.contributor.authorPenn, Andrew M
dc.contributor.authorCroteau, Nicole S
dc.contributor.authorVotova, Kristine
dc.contributor.authorSedgwick, Colin
dc.contributor.authorBalshaw, Robert F
dc.contributor.authorCoutts, Shelagh B
dc.contributor.authorPenn, Melanie
dc.contributor.authorBlackwood, Kaitlin
dc.contributor.authorBibok, Maximilian B
dc.contributor.authorSaly, Viera
dc.contributor.authorHegedus, Janka
dc.contributor.authorYu, Amy Y X
dc.contributor.authorZerna, Charlotte
dc.contributor.authorKlourfeld, Evgenia
dc.contributor.authorLesperance, Mary L
dc.date.accessioned2019-10-27T00:15:54Z
dc.date.available2019-10-27T00:15:54Z
dc.date.issued2019-10-25
dc.date.updated2019-10-27T00:15:53Z
dc.description.abstractAbstract 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.
dc.identifier.citationBMC Neurology. 2019 Oct 25;19(1):251
dc.identifier.doihttps://doi.org/10.1186/s12883-019-1466-4
dc.identifier.urihttp://hdl.handle.net/1880/111174
dc.language.rfc3066en
dc.rights.holderThe Author(s).
dc.titleSystolic blood pressure as a predictor of transient ischemic attack/minor stroke in emergency department patients under age 80: a prospective cohort study
dc.typeJournal Article
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