Prognostic Significance of Short-Term Blood Pressure Variability in Acute Stroke

Abstract Background Blood pressure variability (BPV) has emerged as an important predictor of future cardiovascular events among hypertensive patients. However, it is not known whether BPV measured with ambulatory monitoring (short-term BPV) or computed from office visits (visit-to-visit BPV) are related to each other and carry similar prognostic significance. Purpose To investigate the association of short-term BPV and visit-to-visit BPVs with cardiovascular and renal events in a young hypertensive cohort untreated at baseline. Methods Short-term BPV was measured from 24-hour blood pressure (BP) monitoring at baseline in 1167 participants with stage 1 hypertension from the HARVEST study, aged 33.1±8.5 years. Visit-to-visit BPV was calculated from office BP measured in triplicate at each visit. Visits were made two weeks apart at baseline, and then after 1 month, 2 months, 3 months, 6 months, and 1 year. Only untreated subjects were taken into account for the analysis. Hazard ratios for short-term (weighted 24-hour BP Standard Deviation) and visit-to-visit Standard Deviation were computed, adjusting for the corresponding average BP, age, sex, body mass index, 24h heart rate, smoking, alcohol and coffee consumption, physical activity, parental cardiovascular disease, glucose, total cholesterol, HDL-cholesterol, and nocturnal BP dipping. Results Short-term systolic BPV showed a weak correlation with visit-to-visit BPV (p=0.018). No correlation was found for diastolic BPVs. Independent predictors of short-term BPV were average 24h BP, smoking, and nocturnal dipping. Predictors of visit-to-visit BPV were average office BP, parental cardiovascular disease, female gender, and nocturnal dipping. During a 15.4-year follow-up, 95 end-points were observed. In a parsimonious multivariable Cox model, short-term systolic BPV (p=0.03) was an independent predictor of the endpoints with a 7% increase in risk for each 1 mmHg increment in systolic BPV. The hazard ratio for a short-term systolic BPV ≥12.8 mmHg was 2.03 (95% CI, 1.34–3.05, p=0.0007). This threshold value was identified by ROC curve analysis. The association was particularly strong for coronary events (N=41) with a hazard ratio of 3.45 (95% CI, 1.73–6.89, p=0.0004). No independent association with outcome was found for visit-to-visit systolic or diastolic BPV (p>0.66). Similar results were obtained when average real variability was used instead of standard deviation as a metric of visit-to-visit BPV (p>0.15). Conclusions These data show that in untreated young hypertensive people short-term BPV and visit-to-visit BPV have a weak relationship and a different clinical significance. Only short-term BPV measured with ambulatory monitoring improved traditional risk prediction models in this setting. Acknowledgement/Funding Associazione 18 maggio 1370

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PROGNOSTIC SIGNIFICANCE OF BLOOD PRESSURE VARIABILITY AFTER THROMBOLYSIS IN ACUTE STROKE

Neurology ◽

10.1212/01.wnl.0000346743.58213.4e ◽

2009 ◽

Vol 72 (20) ◽

pp. 1792-1793 ◽

Cited By ~ 2

Author(s):

M. Sykora ◽

J. Diedler ◽

T. Steiner ◽

R. Delgado-Mederos ◽

C. A. Molina

Keyword(s):

Blood Pressure ◽

Acute Stroke ◽

Blood Pressure Variability ◽

Prognostic Significance

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How important is blood pressure variability?

European Heart Journal Supplements ◽

10.1093/eurheartj/suaa061 ◽

2020 ◽

Vol 22 (Supplement_E) ◽

pp. E1-E6 ◽

Cited By ~ 3

Author(s):

Enrico Agabiti Rosei ◽

Giulia Chiarini ◽

Damiano Rizzoni

Keyword(s):

Blood Pressure ◽

Cardiovascular Risk ◽

Blood Pressure Variability ◽

Prognostic Significance ◽

Early Morning ◽

Continuous Variable ◽

Short Term ◽

Arterial Blood ◽

Relevant Risk Factor

Abstract Arterial blood pressure (BP) is a continuous variable, with a physiology characterized by significant variability stemming from the complex interaction among haemodynamic factors, neuronal reflexes, as well as hormonal, behavioural, and environmental stimuli. The homoeostatic response accounts for the physiologic variability in BP in normotensive individuals, which is more evident in hypertensive patients. Blood pressure variability is a complex phenomenon, which could be classified in various types: very short term (beat to beat), short term (during 24 h), mid-term (day by day), long term (<5 years), and very long term (>5 years). Accurate measurement of BP variability represents a complex and often controversial endeavour, despite several methodological approaches are available. Albeit a prognostic significance has been demonstrated for some indicators of BP variability, the clinical significance of this measurement is still uncertain. In fact, none of the indicators presently available for BP variability, including early morning BP rise, substantially affects, and redefines, the cardiovascular risk of the hypertensive patient, over and beyond the mere BP values. Accordingly, in defining the cardiovascular risk, the focus should be on the absolute BP values, which remain the most relevant risk factor, and the one more susceptible to modification with both non-pharmacologic and pharmacologic treatment.

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Association Between Blood Pressure Variability and Short-Term Outcome After Intra-arterial Thrombectomy in Acute Stroke Patients With Large-Vessel Occlusion

Frontiers in Neurology ◽

10.3389/fneur.2020.604437 ◽

2021 ◽

Vol 11 ◽

Author(s):

Mengqi Yang ◽

Tao Lu ◽

Baohui Weng ◽

Yi He ◽

Hong Yang

Keyword(s):

Blood Pressure ◽

Confidence Interval ◽

Acute Stroke ◽

Blood Pressure Variability ◽

Large Vessel Occlusion ◽

Stroke Patients ◽

Short Term ◽

Vessel Occlusion ◽

Term Outcome ◽

Short Term Outcome

The optimal range of blood pressure variability (BPV) for acute stroke patients with large-vessel occlusion (LVO) remains unclear. This study investigated the association between BPV from admission through the first 24 h after intra-arterial thrombectomy (IAT) and short-term outcome in LVO patients. We retrospectively analyzed 257 consecutive patients with LVO stroke who were treated with IAT. BP values were recorded at 2-h intervals from admission through the first 24 h after IAT. BPV, as reflected by pulse pressure variability (PPV), was determined based on standard deviation (SD), coefficient of variation (CV), successive variation (SV), and the difference between maximum and minimum blood pressure (ΔBP; systolic BP minus diastolic BP). The association between BPV and clinical outcome (Modified Rankin Scale score at 90 days) was analyzed by multivariate logistic regression analysis. Of the 257 included patients, 70 had a good outcome at 3 months. PPV from admission through the first 24 h after IAT was independently associated in a graded manner with poor outcome [multivariable-adjusted odds ratios (95% confidence interval) for the highest of PPV were 43.0 (8.7–212.8) for SD, 40.3 (9.8–165.0) for CV, 55.0 (11.2–271.2) for SV, and 40.1 (8.0–201.9) for ΔBP]. The area under the receiver operating characteristic curve (95% confidence interval) of the PPV parameters were 0.924 (0.882–0.965) for SD, 0.886 (0.835–0.938) for CV, 0.932 (0.891–0.973) for SV, and 0.892 (0.845–0.939) for ΔBP, and the Youden index values were 0.740, 0.633, 0.759, and 0.756, respectively. In summary, BPV from admission through the first 24 h after IAT was independently associated with poor outcome at 3 months in patients with LVO, with greater variability corresponding to a stronger association. Thus, PPV may be a clinically useful predictor of functional prognosis in LVO patients treated with IAT.

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