AUTHOR=Bahouth Mona N. , Saylor Deanna , Hillis Argye E. , Gottesman Rebecca F. 

TITLE=The Impact of Mean Arterial Pressure and Volume Contraction in With Acute Ischemic Stroke

JOURNAL=Frontiers in Neurology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.766305

DOI=10.3389/fneur.2022.766305

ISSN=1664-2295

ABSTRACT=Background and Purpose: Hydration at the time of stroke may impact functional outcome. We sought to investigate the relationship between blood pressure, hydration status, and stroke severity in patients with acute ischemic stroke.

Methods: We evaluated hydration status, determined by BUN/creatinine ratio, in consecutive acute ischemic stroke patients from a single comprehensive stroke center. Baseline mean arterial pressure (MAP) was analyzed using a linear spline with a knot at 90mmHg. Baseline stroke severity was defined based on admission NIH Stroke Scale scores (NIHSSS) and MRI diffusion-weighted imaging. 

Results: Among 108 eligible subjects, 55 (51%) presented in a volume contracted state. In adjusted models, in the total sample, for every 10mmHg higher MAP up to 90mmHg, NIHSSS was 2.8 points lower (p=0.053), without further statistically significant association between MAP above 90 and NIHSSS. This relationship was entirely driven by the individuals in a volume contracted state: MAP was not associated with NIHSSS in individuals who were euvolemic. For individuals in a volume contracted state, each 10 mmHg higher MAP, up to 90mmHg, was associated with 6.9 points lower NIHSSS (95% CI -11.1, -2.6). MAP values above 90mmHg were not related to NIHSSS in either dehydrated or euvolemic patients.

Conclusions: Lower MAP contributes to more severe stroke in patients who are volume contracted, but not those who are euvolemic, suggesting that hydration status and blood pressure may jointly contribute to outcome. Hydration status should be considered when setting blood pressure goals for acute ischemic stroke patients.