Mid-Term Blood Pressure Variability Is Associated With Clinical Outcome After Ischemic Stroke

Background: Blood pressure variability (BPV) is associated with target organ damage progression and increased cardiovascular events, including stroke. The aim of this study was to evaluate the associations between short-term BPV during acute periods and recanalization degree, early neurological deterioration (END) occurrence, and functional outcomes in acute ischemic stroke patients who had undergone intra-arterial thrombectomy (IAT). Methods: We retrospectively analyzed 303 patients with large vessel occlusive stroke who underwent IAT. The following BPV parameters, measured over 24 and 48 h after IAT, were compared: the mean, SD, coefficient of variation (CV), variation independent of the mean (VIM) for both the systolic BP (SBP) and diastolic BP, and the proportion of nocturnal SBP risers. Results: BPV parameters decreased with higher recanalization degree. The mean SBP (SBPmean) over 24 and 48 h after IAT, and the SD of SBP (SBPSD), CV of SBP (SBPCV), and VIM of SBP (SBPVIM) during the 48 h following the procedure had significant associations with recanalization degree. Patients with END had higher BPV than that of those without END, and the difference was more evident for incomplete recanalization. Increased BPV was associated with a shift toward poor functional outcome at 3 months after adjustment, including recanalization degree (OR range for significant parameters, 1.26–1.64, p = 0.006 for 48 h SBPmean, p = 0.003 for 48 h SBPCV, otherwise p < 0.002). Conclusions: Short-term BPV over 24 and 48 h after IAT in acute ischemic stroke patients was related to recanalization degree, and END occurrence, and may be an independent predictor of clinical outcome.

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Abstract WP301: Noninvasive Beat-to-Beat Assessment of Blood Pressure Variability, Heart Rate Variability and Baroreflex Sensitivity: Which Parameters Best Predict Clinical Outcome After Acute Ischemic Stroke?

Stroke ◽

10.1161/str.47.suppl_1.wp301 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Li Xiong ◽

Ge Tian ◽

Xiangyan Chen ◽

Howan Leung ◽

Thomas Leung ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Heart Rate Variability ◽

Ischemic Stroke ◽

Clinical Outcome ◽

Blood Pressure Variability ◽

Baroreflex Sensitivity ◽

Low Frequency ◽

Prognostic Information ◽

Power Spectral

Background and Objectives: Blood pressure variability (BPV), heart rate variability (HRV) and baroreflex sensitivity (BRS) as measures of autonomic function might provide prognostic information in ischemic stroke. We aimed to study noninvasive beat-to-beat assessment of BPV, HRV and BRS in the acute phase of ischemic stroke to determine whether any of them predicted clinical outcome. Methods & Patients: Consecutive ischemic stroke patients within 7 days of symptom onset were enrolled. The frequency components of BPV and HRV by means of power spectral analysis [very low frequency (VLF; < 0.04 Hz); low frequency (LF; 0.04-0.15 Hz); high frequency (HF; 0.15-0.40 Hz); power spectral density (PSD; <0.40 Hz) and LF/HF ratio] were calculated from 10-minute recordings of beat-to-beat blood pressure and heart rate monitoring. The baroreflex slope and baroreflex effectiveness index (BEI) were determined using the sequence method for BRS. Clinical outcome was assessed at 3 months after stroke onset as good or poor by modified Rankin Scale (mRS) (good outcome, mRS ≤ 2). Results: 82 patients were recruited (mean age, 64.6 ± 9.9 years; 89.3% males). Univariate analysis showed that there were significant differences in National Institutes of Health Stroke Scale (NIHSS) at recruitment, VLF diastolic BPV, VLF, HF and PSD systolic BPV, and down ramp BEI between the good and poor outcome groups (all P < 0.05). After adjusting for NIHSS, multivariate logistic regression showed that only HF systolic BPV (OR 1.320; 95% CI, 1.050-1.659; P=0.017) and down BEI (OR 0.950; 95% CI, 0.912-0.990; P=0.014) were independently correlated with poor functional outcome. Conclusions: Beat-to beat highly variable systolic blood pressure and impaired BRS as evaluated by decreased down BEI are associated with an unfavorable functional outcome after acute ischemic stroke. Important prognostic information can be readily obtained from a short period of noninvasive hemodynamics monitoring in the acute stroke patient.

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Systolic blood pressure variability following endovascular thrombectomy and clinical outcome in acute ischemic stroke: A meta‐analysis

Acta Neurologica Scandinavica ◽

10.1111/ane.13480 ◽

2021 ◽

Author(s):

Gaurav Nepal ◽

Gentle Sunder Shrestha ◽

Yow Ka Shing ◽

Allison Muha ◽

Riwaj Bhagat

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Clinical Outcome ◽

Systolic Blood Pressure ◽

Acute Ischemic Stroke ◽

Blood Pressure Variability ◽

Meta Analysis ◽

Endovascular Thrombectomy ◽

Systolic Blood Pressure Variability

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Blood Pressure Variability in Acute Ischemic Stroke: The Role of Early Recanalization

European Neurology ◽

10.1159/000492627 ◽

2018 ◽

Vol 80 (1-2) ◽

pp. 63-67 ◽

Cited By ~ 5

Author(s):

Ana Inês Martins ◽

João Sargento-Freitas ◽

Joana Jesus-Ribeiro ◽

Inês Correia ◽

Leila Cardoso ◽

...

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Retrospective Study ◽

Clinical Outcome ◽

Functional Outcome ◽

Blood Pressure Variability ◽

Multivariate Analyses ◽

Modified Rankin Scale ◽

Arterial Recanalization

We performed a retrospective study with the aim of investigating the association between blood pressure (BP) variability in the first 24 h after ischemic stroke and functional outcome, regarding arterial recanalization status. A total of 674 patients diagnosed with acute stroke and treated with revascularization therapies were enrolled. Systolic and diastolic BP values of the first 24 h after stroke were collected and their variation quantified through standard deviation. Recanalization state was evaluated at 6 h and clinical outcome at 3 months was assessed by modified Rankin Scale. In multivariate analyses systolic BP variability in the first 24 h post-stroke showed an association with 3 months clinical outcome in the whole population and non-recanalyzed patients. In recanalyzed patients, BP variability did not show a significant association with functional outcome.

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SYSTOLIC BLOOD PRESSURE VARIABILITY DURING MECHANICAL THROMBECTOMY IS ASSOCIATED WITH EARLY NEUROLOGICAL DETERIORATION IN ACUTE ISCHEMIC STROKE PATIENTS

10.26226/morressier.58e389aed462b80292385662 ◽

2017 ◽

Author(s):

João Pedro Marto

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Systolic Blood Pressure ◽

Acute Ischemic Stroke ◽

Blood Pressure Variability ◽

Mechanical Thrombectomy ◽

Neurological Deterioration ◽

Stroke Patients ◽

Early Neurological Deterioration ◽

Systolic Blood Pressure Variability

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Impact of Early Blood Pressure Lowering in Patients Presenting with Acute Ischemic Stroke

Current Cardiology Reports ◽

10.1007/s11886-021-01497-0 ◽

2021 ◽

Vol 23 (6) ◽

Author(s):

A. Maud ◽

G. J. Rodriguez ◽

A. Vellipuram ◽

F. Sheriff ◽

M. Ghatali ◽

...

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Clinical Outcome ◽

Acute Ischemic Stroke ◽

Negative Impact ◽

Systemic Blood Pressure ◽

Hemodynamic Response ◽

Collateral Flow ◽

Early Management ◽

Ischemic Tissue

Abstract Purpose of Review In this review article we will discuss the acute hypertensive response in the context of acute ischemic stroke and present the latest evidence-based concepts of the significance and management of the hemodynamic response in acute ischemic stroke. Recent Findings Acute hypertensive response is considered a common hemodynamic physiologic response in the early setting of an acute ischemic stroke. The significance of the acute hypertensive response is not entirely well understood. However, in certain types of acute ischemic strokes, the systemic elevation of the blood pressure helps to maintain the collateral blood flow in the penumbral ischemic tissue. The magnitude of the elevation of the systemic blood pressure that contributes to the maintenance of the collateral flow is not well established. The overcorrection of this physiologic hemodynamic response before an effective vessel recanalization takes place can carry a negative impact in the final clinical outcome. The significance of the persistence of the acute hypertensive response after an effective vessel recanalization is poorly understood, and it may negatively affect the final outcome due to reperfusion injury. Summary Acute hypertensive response is considered a common hemodynamic reaction of the cardiovascular system in the context of an acute ischemic stroke. The reaction is particularly common in acute brain embolic occlusion of large intracranial vessels. Its early management before, during, and immediately after arterial reperfusion has a repercussion in the final fate of the ischemic tissue and the clinical outcome.

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Abstract 16967: Increased Blood Pressure Variability is Associated With Worse Outcome in Acute Ischemic Stroke

Circulation ◽

10.1161/circ.132.suppl_3.16967 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Adam de Havenon ◽

Haimei Wang ◽

Greg Stoddard ◽

Lee Chung ◽

Jennifer Majersik

Keyword(s):

Blood Pressure ◽

Logistic Regression ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Blood Pressure Variability ◽

Harmful Effect ◽

Final Analysis ◽

Ordinal Logistic Regression ◽

Stroke Severity ◽

The Mean

Background: Increased blood pressure variability (BPV) is detrimental in the weeks to months after ischemic stroke, but it has not been adequately studied in the acute phase. We hypothesized that increased BPV in acute ischemic stroke (AIS) patients would be associated with worse outcome. Methods: We retrospectively reviewed inpatients at our hospital between 2010-2014 with an ICD-9 code of AIS; 213 were confirmed to have AIS by a vascular neurologist. A modified Rankin Score (mRS) after discharge was available in 148/213, at a mean of 86 ± 60 days. In 45/213 the discharge mRS was either 0 or 6, in which case they were included in the final analysis. BPV was measured as the standard deviation (SD) of each patient’s systolic blood pressure readings during the first 24 hours and 5 days of hospitalization (9,844 total readings), or until discharge if discharged in <5 days (Figure 1). The SBP SD was further divided in quartiles. A multivariate ordinal logistic regression with the outcome of mRS, the primary predictor of quartiles of SBP SD, and baseline NIH stroke scale (NIHSS) to control for initial stroke severity. Results: Mean±SD age was 64.2 ± 16.3 years, NIHSS was 12.6 ± 7.9, and mRS was 2.7 ± 2.1. The mean SBP SDs for the first 24 hours and 5 days were 12.1 ± 6.2 mm Hg and 14.1 ± 4.9 mm Hg. In the ordinal logistic regression model, the quartiles of SBP SD for the first 24 hours and 5 days were positively associated with higher mRS (OR = 1.37, 95% CI 1.01 - 1.74, p = 0.009; OR = 1.30, 95% CI 1.03 - 1.63, p = 0.028). This effect became even more pronounced in patients with the highest quartile of variability (OR = 2.76, 95% CI 1.29 - 5.88, p = 0.009; OR = 2.10, 95% CI 1.01 - 4.36, p = 0.046). Conclusion: In our cohort of 193 patients with AIS, there was a significant association between increased systolic BPV and worse functional outcome, after controlling for initial stroke severity. This data suggests that increased BPV may have a harmful effect for AIS patients, which warrants a prospective observational study.

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