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

• Published in: BMC neurology Vol. 19; no. 1; p. 251
• Main Authors: 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
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 25-10-2019; BioMed Central; BMC
• Subjects: Aged; Blood pressure; Blood Pressure - physiology; Control; Diagnosis; Elderly patients; Emergency medicine; Emergency Service, Hospital; Female; Health aspects; Hospital emergency services; Humans; Hypertension - epidemiology; Ischemia; Ischemic Attack, Transient - physiopathology; Male; Management; Medical research; Middle Aged; Minor stroke; Physicians; Risk Factors; Stroke; Stroke - physiopathology; TIA; Transient ischemic attack; Blood pressure; Minor stroke; Transient ischemic attack; TIA; Emergency medicine
• ISSN: 1471-2377; 1471-2377
• DOI: 10.1186/s12883-019-1466-4

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.
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.
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).
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.
ClinicalTrials.gov NCT03050099 (10-Feb-2017) and NCT03070067 (3-Mar-2017). Retrospectively registered.