Abstract WP280: Systolic Blood Pressure During Presentation of Acute Ischemic Stroke Predicts Cardioembolic Etiology

Introduction: Determining stroke etiology is essential to stroke prevention. Deciding which patients require extensive cardiac investigations, and with what priority, is a topic of controversy. Hypothesis: We hypothesize that a lack of hypertension at the time of presentation with acute ischemic stroke predicts cardioembolic etiology. Methods: Patients presenting with acute (< 6 hours) ischemic stroke were consecutively enrolled from a single institution between 2015 and 2017. The primary outcome was cardioembolic etiology diagnosis at 6 months. Presenting systolic blood pressure was categorized as: hypotensive (<110 mmHg), normotensive (110-149 mmHg), and hypertensive (>150 mmHg). Multivariable logistic regression was used to adjust for relevant covariates, which were selected via exploratory univariate analysis (p<0.1). Results: Of the 151 patients included in primary analysis, 64 (42%) were diagnosed with a cardioembolic source at 6 months. After adjusting for age, known cardiac disease (atrial fibrillation, congestive heart failure, valvular disease), and clinical severity, patients presenting with hypo or normotensive systolic pressure were significantly associated with cardioembolic diagnosis at 6 months (n= 37, aOR 3.25, 95% CI: 1.17- 9.06). The association between systolic pressure and cardioembolic diagnosis increased in a dose-like manner (hypotensive: aOR 7.66, 95% CI: 0.80-73.30, normotensive: aOR 2.99, 95% CI: 1.04-8.58). Conclusions: This study provides preliminary confirmation of our hypothesis that patients who are not hypertensive at the time of acute ischemic stroke are more likely to have suffered a stroke that is cardioembolic in origin. These patients may warrant more thorough cardiac investigations or other alterations to management.