Introduction:
There has been increasing evidence that higher systolic blood pressure variability (SBPV) is related to unfavorable outcomes in patients with stroke. We explored the relation between SBPV and clinical outcomes after reperfusion therapy; intravenous thrombolysis (IVT) and endovascular therapy (EVT).
Methods:
We retrieved data of consecutive patients with acute ischemic stroke (AIS) treated with reperfusion therapy from our prospective stroke registry between October 2005 and December 2018. We calculated the following five SBPV during 24 hours after IVT or EVT; mean, standard deviation (SD), coefficient of variation (CV), successive variation (SV), and average real variability (ARV). Clinical outcomes included unfavorable outcomes as modified Rankin Scale (mRS) score 3-6 at 3 months and symptomatic intracranial hemorrhage (sICH) as any hemorrhage with neurological deterioration of 4 points of more on the National Institute of Health Stroke Scale (NIHSS). Successful reperfusion was indicated with early neurological improvements of 4 points of more on the NIHSS after IVT alone or Thrombolysis in Cerebral Infarction scores of 2b or 3 after EVT alone or EVT combined with IVT.
Results:
Among 933 patients with premorbid mRS scores of 0-1 (72±12 years; 316 women), 426 patients with unfavorable outcomes and 35 patients with sICH were observed. In adjusted analyses, all measures of SBPV but CV were related to unfavorable outcomes, while all measures of SBPV but mean SBP were related to sICH. In 566 patients with successful reperfusion, 228 patients with unfavorable outcomes and 10 patients with sICH were observed. In adjusted analyses, all measures of SBPV but mean SBP were positively related to unfavorable outcomes, while no measures of SBPV were independently related to sICH (table).
Conclusion:
High SBPV after successful reperfusion therapy contributed to unfavorable outcomes, suggesting high SBPV after reperfusion therapy might need more attention.
Prognostic significance of early systolic blood pressure variability after endovascular thrombectomy and intravenous thrombolysis in acute ischemic stroke: A systematic review and meta‐analysis
