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

Mona N Bahouth; Deanna Saylor; Argye E Hillis; Rebecca F Gottesman

doi:10.3389/fneur.2022.766305

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

Front Neurol. 2022 Mar 8:13:766305. doi: 10.3389/fneur.2022.766305. eCollection 2022.

Authors

Mona N Bahouth^{1

2}, Deanna Saylor¹, Argye E Hillis¹, Rebecca F Gottesman^{1

3}

Affiliations

¹ School of Medicine, Johns Hopkins University, Baltimore, MD, United States.
² School of Nursing, Johns Hopkins University, Baltimore, MD, United States.
³ School of Public Health, Johns Hopkins University, Baltimore, MD, United States.

Abstract

Background and purpose: Hydration at the time of stroke may impact functional outcomes. We sought to investigate the relationship between blood pressure, hydration status, and stroke severity in patients with acute ischemic stroke (AIS).

Methods: We evaluated hydration status, determined by blood urea nitrogen (BUN)/creatinine ratio, in consecutive patients with AIS from a single comprehensive stroke center. Baseline mean arterial pressure (MAP) was analyzed using a linear spline with a knot at 90 mmHg. 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 10 mmHg higher MAP up to 90 mmHg, 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 90 mmHg, was associated with 6.9 points lower NIHSSS (95% CI -11.1, -2.6). MAP values above 90 mmHg 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 the outcome. Hydration status should be considered when setting blood pressure goals for patients with AIS.

Keywords: acute ischemic stroke; blood pressure; early recovery; hospital care; hydration; stroke severity.