Association of prehospital hypertension and bradycardia with stroke: A single center observational study

Abstract Objective We investigated the relationship between prehospital systolic blood pressure (SBP) and pulse rate (PR) with stroke in patients with impaired consciousness. Methods We included adult patients with impaired consciousness admitted to the emergency department, categorizing them into nine groups based on SBP (≤99, 100–139, and ≥140 mmHg) and PR (≤59, 60–99, and ≥100/min). We analyzed the association between these groups and stroke and compared with the reference group (SBP 100–139 mmHg and PR 60–99/min) using logistic regression models. Results 837 patients were eligible (132 [16%] patients had a stroke). Groups with SBP ≥140 mmHg had a significantly higher risk of stroke regardless of PR (the adjusted odds ratio and 95% confidence interval in the group with PR ≤ 59/min, PR 60–99/min, and PR ≥ 100/min were 4.64 [1.63–13.20], 5.61 [3.24–9.70], and 2.84 [1.45–5.58], respectively). Similarly, among patients with severely impaired consciousness (≥Japan Coma scale III‐100), those with SBP ≥ 140 mmHg were at a significantly higher risk of stroke; within these groups, the group with SBP ≥ 140 mmHg and PR ≤ 59/min had the highest risk of stroke (the odds ratio and 95% confidence interval in the group with PR ≤ 59/min, PR 60–99/min and PR ≥ 100/min were 11.00 [1.70–72.90], 9.29 [3.34–26.00], and 4.83 [1.62–14.40], respectively). Conclusions Prehospital hypertension in patients with impaired consciousness was associated with a significantly higher risk of stroke. In patients with severely impaired consciousness, prehospital hypertension with bradycardia was significantly associated with the highest risk of stroke.