| Background and purpose: Hypertention or elevated blood pressure is the most important risk factor for the incidence of stroke, but the relationships between systolic blood pressure(SBP), diastolic blood pressure(DBP), pulse pressure(PP) , mean arterial pressure(MAP) and clinical outcome of acute stroke are still inconclusive. We studied the associations between these four admission blood pressure indexes and in-hospital death or dependency among acute stroke patients in Inner Mongolia to provide scientific evidence for the effective control of blood pressure.Method: A total of 4,761 stroke patients in six hospitals from January, 2003 to December, 2006 were included in the present study. Data on demographic characteristics, lifestyle risk factors, blood pressure, clinical laboratory test, medical history and clinical outcomes, including death and disability (Modified Rankin's scale, MRs≥3), on discharge were all collected within the first 24-hours of hospital admission using a standard questionnaire administered by trained staff. Statistic analysis was conducted using SPSS15.0 software. The rates of case-fatality and disability were calculated and compared between ischemic stroke and hemorrhagic stroke patients, and the differences of baseline characteristics including demographic and clinical characteristics were compared between ischemic and hemorrhagic stroke patients and between patients with various clinical outcomes in each stroke subtypes. Multiple logistic regression was used to analyse the relationships between these four admission blood pressure indexes and in-hospital death or dependency among acute stroke patients,which were evaluated by the odds ratio(ORs) and 95% confidence interval(95% CI).Results: During the hospitalization, the case-fatality rate and disability rate were 1.6% and 45.5% in ischemic stroke patients and were 5.6% and 38.2% in hemorrhagic stroke patients. The rates of history of diabetes and dyslipidemia were higher for acute ischemic stroke patients (11.4%, 53.9%) compared with acute hemorrhagic stroke patients (2.2%, 44.4%), P<0.05. The rates of history of hypertention and hyperglycaemia (54.0%, 39.2%) for ischemic stroke patients were lower than those for hemorrhagic stroke patients(59.2%, 53.2%), P<0.05. The mean levels of SBP, DBP, PP and MAP were higher in acute hemorrhagic stroke patients than those in acute ischemic stroke patients (SBP 173.7±34.0 vs 151.6±28.2 mmHg; DBP 104.8±19.0 vs 92.2±16.5 mmHg; PP 69.0±23.7 vs 59.5±19.5 mmHg; MAP 127.8±22.4 vs 112.0±19.0 mmHg), all P<0.05.In acute ischemic stroke patients, the rates of history of diabetes and hyperglycaemia(25.0%, 92.9%) were higher in the death group compared with the MRs<3 group (10.4%, 38.6%). The rates of cigarette smoking and alcohol drinking were higher in disability group compared with the MRs<3 group (28.7% vs 24.1%, 23.5% vs 19.6%).Compared with the disability group(12.2%, 38.4%), the rates of history of diabetes and hyperglycaemia were higher in the death group(25.0%, 92.9%).In acute hemorrhagic stroke patients, the rate of hyperglycaemia was higher for the death group (79.6%) compared with the MRs<3 group (51.6%). The mean levels of SBP, DBP, PP and MAP in the death group were higher than those in the MRs<3 group(SBP 195.4±38.8 vs. 171.6±34.6 mmHg, DBP 112.6±22.1 vs. 103.5±19.0 mmHg, PP 82.8±31.0 vs. 68.2±23.8 mmHg, MAP 140.2±24.8 vs. 126.2±22.7 mmHg). The rate of Mongolian ethnicity was higher for the MRs<3 group(27.6%) compared with the death group(14.0%).Compared with the MRs<3 group(57.4%), the rate of history of hypertention was higher for the disability group(63.3%). The rate of hyperglycaemia(79.6%) was higher in the death group, compared with the disability group(52.8%). The mean levels of SBP, DBP, PP and MAP in the death group were higher than those in the disability group (SBP 195.4±38.8 vs. 173.6±31.1 mmHg, DBP 112.6±22.1 vs. 105.5±18.3 mmHg, PP 82.8±31.0 vs. 68.1±21.4 mmHg, MAP 140.2±24.8 vs. 128.2±21.1 mmHg).The rates of Mongolian ethnicity and history of hypertention were higher for the disability group (26.3%,63.3%) compared with the death group(14.0%,49.0%).All these four blood pressure indexes on admission were significantly associated with in-hospital death among hemorrhagic stroke patients. For example, compared to those with SBP<140 mmHg, multivariate-adjusted OR(95% CI) of death was 3.029(1.361, 6.740) among patients with SBP≥180 mmHg, P<0.05.Compared to those with DBP<90 mmHg, multivariate-adjusted OR(95% CI) of death was 2.499(1.219, 5.121) among patients with DBP≥110 mmHg, P<0.05. Compared to those with PP<51 mmHg, multivariate-adjusted OR(95% CI) of death was 3.443(1.968, 6.023) among patients with PP≥81 mmHg, P<0.05. Compared to those with MAP<113 mmHg, multivariate-adjusted OR(95% CI) of death was 2.994(1.693, 5.294) among patients with MAP≥144mmHg, P<0.05.SBP,DBP and MAP on admission were all positively and significantly associated with in-hospital disability among hemorrhagic stroke patients.For example, compared to those with SBP<140mmHg, multivariate-adjusted ORs(95% CI) of disability were 1.621(1.105, 2.377),1.455(1.005, 2.106) and 1.680(1.194, 2.363) among patients with SBP 140-159, 160-179 and≥180 mmHg, respectively, all P<0.05.Compared to those with DBP<90mmHg, multivariate-adjusted ORs(95% CI) of disability were 1.542(1.084, 2.192), 1.633(1.184, 2.251) and 1.610(1.193, 2.171) among patients with DBP 90-99, 100-109 and≥110mmHg, respectively, all P<0.05. Compared to those with MAP<113mmHg, multivariate-adjusted ORs(95% CI) of disability were 1.492(1.141, 1.952) and 1.455(1.100, 1.925) among patients with MAP 113-127 and≥144mmHg, all P<0.05.SBP,DBP and MAP on admission were all positively and significantly associated with in-hospital combined outcome among hemorrhagic stroke patients. For example, compared to those with SBP<140mmHg, multivariate-adjusted ORs(95% CI) of combined outcome were 1.596(1.113, 2.288),1.463(1.037, 2.064) and 1.799(1.313, 2.465) among patients with SBP 140-159, 160-179 and≥180 mmHg, respectively, all P<0.05.Compared to those with DBP<90mmHg, multivariate-adjusted ORs(95% CI) of combined outcome were 1.506 (1.066, 2.128), 1.584(1.156, 2.170) and 1.666 (1.244, 2.232) among patients with DBP 90-99, 100-109 and≥110mmHg, respectively, all P<0.05. Compared to those with MAP<113mmHg, multivariate-adjusted ORs (95% CI) of combined outcome were 1.386(1.063, 1.806) and 1.653(1.256, 2.175) among patients with MAP 113-127 and≥144mmHg, all P<0.05.All these four blood pressure indexes on admission had no relationship with in-hospital death and dependency among ischemic stroke patients, all P>0.05.Conclusion: Increased level of SBP, DBP, MAP on admission were all positively and significantly associated with in-hospital death and disability on discharge among patients with hemorrhagic stroke. Elevated PP was only associated with in-hospital death among hemorrhagic stroke patients. While for ischemic stroke patients, the relationships between SBP, DBP, PP, MAP and in-hospital death and dependency on discharge were not significant.
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