Abstract T MP75: Effect of Subacute BP Variability on Subsequent Vascular Events in Patients with Acute Ischemic Stroke

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Jihoon Kang ◽  
Min Uk Jang ◽  
Hong-Kyun Park ◽  
Jeong-Ho Hong ◽  
Min Ju Yeo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Dose Response ◽  
Blood Pressure Variability ◽  
Rank Test ◽  
Vascular Events ◽  
Stroke Registry ◽  
Subacute Stage ◽  
Maximum Minimum

Objectives: We recently reported that blood pressure variability (BPV) during a subacute stage of ischemic stroke may affect functional outcome. This study aimed to test a hypothesis whether subacute BPV increases a risk of subsequent vascular events following acute ischemic stroke. Methods: From a prospective stroke registry database, consecutive ischemic stroke patients hospitalized within 48 h of onset were identified. Subacute BPV parameters were defined as maximum 2 -minimum, standard deviation (SD) and coefficient of variation (CV) of systolic BP (SBP) from 72 hours after onset to discharge. Primary outcome was a time to a subsequent vascular event (SVE), which was a composite of stroke, myocardial infarction and other vascular death. The BPV parameters were categorized into tertiles and dose-response relationships between BPV parameters and SVE were examined. The hazard ratios (HRs) of BPV parameters were estimated using Cox proportional hazard models with adjustments for predetermined confounders. Result: Of 3047 patients (mean age, 66.4 years and median NIHSS score, 3); BP was measured by median 46 times per person during the subacute stage (median 7 days). Median follow-up duration was 352 days (interquartile range, 112 to 389 days) and cumulative SVE rates were 7.0%. SVE rates differed by the tertiles of BPV parameters; SVE rates of lower, middle and upper thirds of maximum-minimum were 5.2%, 6.4% and 9.6%, those of SD were 5.4%, 8.5% and 7.9% and those of CV were 4.9%, 8.4% and 7.6%, respectively (P’s < 0.05 on log rank test). There were significant dose-response relationships of SVE with maximum-minimum and SD (P < 0.01 and 0.01), not with CV (P = 0.14) independent of mean SBP, age, sex, history of stroke, hypertension, diabetes mellitus, hyperlipidemia, atrial fibrillation and stroke subtypes. Adjusted HRs of one-SD of maximum-minimum, SD and CV of SBP were 1.24 (95% confidence interval, 1.09-1.40), 1.16 (1.01-1.32) and 1.15 (1.01-1.30), respectively. Conclusion: This study suggests that the increase of blood pressure variability at subacute stage of ischemic stroke may increase the risk of subsequent vascular events.

Blood pressure variability in subacute stage and risk of major vascular events in ischemic stroke survivors

2019 ◽  
Vol 37 (10) ◽  
pp. 2000-2006
Author(s):  
Jihoon Kang ◽  
Beom Joon Kim ◽  
Mi Hwa Yang ◽  
Myung Suk Jang ◽  
Moon-Ku Han ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Blood Pressure Variability ◽  
Stroke Survivors ◽  
Vascular Events ◽  
Subacute Stage

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

Circulation ◽  
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.

Abstract 65: Effects of Immediate Blood Pressure Reduction on Two-Year Mortality and Major Disability in Patients With Acute Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Jiang He ◽  
Yonghong Zhang ◽  
Tan Xu ◽  
Dali Wang ◽  
Chung-Shiuan Chen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Treatment Group ◽  
Acute Ischemic Stroke ◽  
Antihypertensive Treatment ◽  
Blood Pressure Reduction ◽  
Control Group ◽  
Antihypertensive Medications ◽  
Vascular Events

Although elevated blood pressure (BP) is very common in patients with acute ischemic stroke, the management of hypertension among them remains controversial. We tested the effect of immediate BP reduction on two-year mortality and major disability in acute ischemic stroke patients. The China Antihypertensive Trial in Acute Ischemic Stroke, a randomized, single-blind, blinded end-points trial, was conducted in 4,071 patients with ischemic stroke within 48 hours of onset and elevated systolic BP (SBP). Patients were randomly assigned to receive antihypertensive treatment (n=2,038) or to discontinue all antihypertensive medications (n=2,033) during hospitalization. Post-treatment follow-ups were conducted at 3, 12, and 24 months after hospital discharge. The primary outcome was a composite of death and major disability at the two-year follow-up visit. Mean SBP was reduced by 21.8 in the treatment group and 12.7 mm Hg in the control group within 24 hours after randomization (P<0.001). Mean SBP was 137.3 mm Hg in the treatment group and 146.5 in the control group at day 7 after randomization (P<0.001). At two-year follow-up, study outcomes were obtained in 1945 (95.4%) participants in the treatment group and 1925 (94.7%) in the control group. 78.8% of the patients in the treatment group and 72.6% in the control group reported the use of antihypertensive medications (p<0.001). SBP was 138.8 mmHg in the antihypertensive treatment group and 139.7 in the control group (p=0.02). Among patients in the antihypertensive treatment group, 24.5% (476/1945) died or had a major disability, compared with 22.1% (425/1925) in the control group (odds ratio 1.14 [95% CI 0.99 to 1.33], p=0.078). Hazard ratios for all-cause mortality (1.01 [0.81, 1.25], p=0.95), recurrent stroke (0.91 [0.73, 1.13], p=0.40), and vascular events (0.97 [0.79, 1.19], p=0.76) were not statistically significant comparing the antihypertensive treatment group to the control group. The effect of antihypertensive treatment did not differ by pre-defined subgroups. In conclusion, among patients with acute ischemic stroke, BP reduction with antihypertensive medications during hospitalization did not reduce or increase the composite outcome of death and major disability over two years.

scholarly journals Predictive Significance of Day-to-Day Blood Pressure Variability in Acute Ischemic Stroke for 12-Month Functional Outcomes

2017 ◽  
Vol 30 (5) ◽  
pp. 524-531 ◽  
Author(s):  
Zhu Shi ◽  
En S. Li ◽  
Jun S. Zhong ◽  
Juan L. Yuan ◽  
Lan R. Li ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcomes ◽  
Blood Pressure Variability

scholarly journals ASSOCIATION BETWEEN BLOOD PRESSURE VARIABILITY AND EARLY NEUROLOGICAL DETERIORATION IN ACUTE ISCHEMIC STROKE PATIENTS

2020 ◽  
Vol 7 (8) ◽  
pp. 94-99
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Significant Relationship ◽  
Blood Pressure Variability ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Cross Sectional ◽  
Exact Test ◽  
Treatment Data

Background: Variability in blood pressure is a predictor of stroke severity and causes of poor functional outcome. Blood pressure variability is one of the main predictor of the prognosis acute ischemic stroke. Blood pressure variability were independently and linearly associated with the development of early neurologic deterioration (END) in acute ischemic stroke Objective: To determine the association between blood pressure variability and END in acute ischemic stroke patients. Method: This study uses a cross sectional design. Sampling was conducted at H. Adam Malik General Hospital Medan. Samples were taken as many as 40 subjects consecutively. Blood pressure checks were perform every hour for 72 hours then an assessment of the National Institute of Health Stroke Scale (NIHSS) score at admission and the third day of treatment. Data analysis used fisher’s exact test. Results: The demographic characteristics of the study subjects were an average age of 56-<71 years, high school education level, housewife occupation and Batak ethnicity. The mean of maximum systolic blood pressure (SBP) was 151±12.16 mmHg, minimum SBP 123.15±18 mmHg, delta SBP 25.35±10.66 mmHg, maximum diastolic blood pressure (DBP) 79.7±6.01 mmHg, minimum DBP 61.77±7.32 mmHg and delta DBP 17.97±8.48 mmHg. The NIHSS day 1 score had an average of 9.55±6.73, the NIHSS day 3 score was 11.25±7.93. Most subjects experienced END. There is a significant relationship between blood pressure variability and END with a p of 0.03 (p<0.05). Conclusion: There is a significant relationship between blood pressure variability and END in patients with acute ischemic stroke.

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