Blood pressure variability and leukoaraiosis in acute ischemic stroke

Higher blood pressure, blood pressure variability, and leukoaraiosis are risk factors for early adverse events and poor functional outcome after ischemic stroke, but prior studies differed on whether leukoaraiosis was associated with blood pressure variability, including in ischemic stroke. In the Third International Stroke Trial, blood pressure was measured in the acute phase of ischemic stroke immediately prior to randomization, and at 0.5, 1, and 24 h after randomization. Masked neuroradiologists rated index infarct, leukoaraiosis, and atrophy on CT using validated methods. We characterized blood pressure variation by coefficient of variance and three other standard methods. We measured associations between blood pressure, blood pressure variability, and leukoaraiosis using generalized estimating equations, adjusting for age, and a number of covariates related to treatment and stroke type/severity. Among 3017 patients, mean (±SD) systolic and diastolic blood pressure decreased from 155(±24)/82(±15) mmHg pre-randomization to 146(±23)/78(±14) mmHg 24 h later ( P < 0.005). Mean within-subject coefficient of variance was 0.09 ± 0.05 for systolic and 0.11 ± 0.06 for diastolic blood pressure. Patients with most leukoaraiosis were older and had higher blood pressure than those with least ( P < 0.0001). Although statistically significant in simple pairwise comparisons, no measures of blood pressure variability were associated with leukoaraiosis when adjusting for confounding variables ( P > 0.05), e.g. age. Our results suggest that blood pressure variability is not a potential mechanism to explain the association between leukoaraiosis and poor outcome after acute stroke.

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Increased blood pressure variability after acute ischemic stroke increases the risk of death: A secondary analysis of the Virtual International Stroke Trial Archive

JRSM Cardiovascular Disease ◽

10.1177/2048004019856496 ◽

2019 ◽

Vol 8 ◽

pp. 204800401985649 ◽

Cited By ~ 2

Author(s):

Adam de Havenon ◽

Greg Stoddard ◽

Monica Saini ◽

Ka-Ho Wong ◽

David Tirschwell ◽

...

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Systolic Blood Pressure ◽

Acute Ischemic Stroke ◽

Diastolic Blood Pressure ◽

Blood Pressure Variability ◽

Risk Of Death ◽

Study Enrollment ◽

Systolic Blood Pressure Variability ◽

Stroke Trial

Background Despite promising epidemiological data, it remains unclear if increased blood pressure variability is associated with death after acute ischemic stroke. Our objective was to examine this association in a large cohort of acute ischemic stroke patients. Methods We conducted a retrospective analysis of anonymized, pooled, participant data from the Virtual International Stroke Trial Archive. We included patients with a 90-day modified Rankin Scale and blood pressure readings in the 24 h after study enrollment. The exposure was blood pressure variability during the day after study enrollment, calculated for the systolic and diastolic blood pressure using six statistical methodologies. The primary outcome was death within 90 days of stroke onset. Results Our cohort comprised 1891 patients of whom 277 (14.7%) died within 90 days. All indices of blood pressure variability were higher in patients who died, but the difference was more pronounced for systolic than diastolic blood pressure variability (systolic standard deviation for alive versus dead patients = 13.4 versus 15.9 mmHg, p < 0.001). Similar results were found in logistic regression models fit to the outcome of death, but only systolic blood pressure variability remained significant in adjusted models (Odds Ratio for death when comparing highest to lowest tercile of systolic blood pressure variability = 1.41–1.89, p < 0.03 for all). Conclusions and relevance: These results reinforce prior studies that found increased blood pressure variability is associated with worse neurologic outcome after stroke. These data should help guide research on blood pressure variability after stroke and advocate for the inclusion of death as a clinical outcome in future studies that therapeutically reduce blood pressure variability.

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Comparison of the Effect of Fimasartan versus Valsartan on Blood Pressure Variability in Acute Ischemic Stroke: A Double-Blind Randomized Trial

Cardiovascular Therapeutics ◽

10.1155/2019/7836527 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8

Author(s):

Dong Hoon Shin ◽

Soohwa Song ◽

Yeong Bae Lee

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Blood Pressure Variability ◽

Controlled Trial ◽

Poor Functional Outcome ◽

Double Blind ◽

Before And After ◽

Average Real Variability ◽

To Receive

Higher blood pressure variability (BPV) is associated with poor functional outcome and mortality in acute stroke. This randomized controlled trial was conducted to compare the effect on BPV between fimasartan and valsartan (Boryung Pharmaceutical Co., Ltd., Seoul, Republic of Korea) in patients with acute ischemic stroke. Eighty patients were randomly assigned to receive either valsartan or fimasartan after 7 days of acute ischemic stroke onset, for duration of 8 weeks. Of them, 62 patients completed the study [valsartan (n=31), fimasartan (n=31)]. We measured BP for 24 hours using ambulatory BP monitoring device before and after 8 weeks of starting BP medication. We calculated several indexes such as standard deviation (SD), weighted 24-hour BP with SD (wSD), coefficient of variation (CV), and average real variability (ARV) to assess BPV and to compare indexes of BPV between 2 drugs. SD values of systolic BP in daytime, nighttime, and 24 h period (15.55±4.02 versus 20.55±8.77, P=0.006; 11.98±5.52 versus 16.47±6.94, P=0.007; 17.22±5.30 versus 21.45±8.51, P=0.024), wSD of systolic BP (8.27±3.01 versus 10.77±4.18, P=0.010), and ARV of systolic BP (15.85±6.17 versus 19.68±7.83, P=0.040) of patients receiving fimasartan after 8 weeks were significantly lower than patients receiving valsartan. In paired t-test, SD values of daytime, nighttime, and 24 h period of systolic BP of patients receiving fimasartan were significantly decreased after 8 weeks (15.55±4.02 versus 18.70±7.04, P=0.038; 11.98±5.52 versus 17.19±7.35, P=0.006; 17.22±5.30 versus 20.59±5.91, P=0.015). Our study showed that fimasartan had greater effect on reducing BPV after acute ischemic stroke than valsartan. Trials registry number is KCT0003254.

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Role of 24-Hr blood pressure variability as a target therapeutic risk factor for poor functional outcome of acute ischemic stroke

Annals of Indian Academy of Neurology ◽

10.4103/aian.aian_373_19 ◽

2020 ◽

Vol 0 (0) ◽

pp. 0

Author(s):

Vinod Khandait ◽

Nithisha Thatikonda ◽

Aditya Shrikhande ◽

Krittika Singh

Keyword(s):

Blood Pressure ◽

Risk Factor ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Blood Pressure Variability ◽

Poor Functional Outcome

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Role of 24 Hr blood pressure variability as a target therapeutic risk factor for poor functional outcome of acute ischemic stroke

Annals of Indian Academy of Neurology ◽

10.4103/aian.aian_519_19 ◽

2020 ◽

Vol 0 (0) ◽

pp. 0

Author(s):

Dinesh Bhatia ◽

S Bagyaraj ◽

SArun Karthick

Keyword(s):

Blood Pressure ◽

Risk Factor ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Blood Pressure Variability ◽

Poor 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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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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Increasing Blood Pressure Variability Predicts Poor Functional Outcome Following Acute Stroke

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2020.105466 ◽

2021 ◽

Vol 30 (1) ◽

pp. 105466

Author(s):

Karen OB Appiah ◽

Mintu Nath ◽

Lisa Manning ◽

William J Davison ◽

Sara Mazzucco ◽

...

Keyword(s):

Blood Pressure ◽

Acute Stroke ◽

Functional Outcome ◽

Blood Pressure Variability ◽

Poor Functional Outcome

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SHORT-TERM FUNCTIONAL OUTCOME AFTER ISCHEMIC STROKE IS RELATED TO BLOOD PRESSURE VARIABILITY

Journal of Hypertension ◽

10.1097/01.hjh.0000539327.94937.78 ◽

2018 ◽

Vol 36 (Supplement 1) ◽

pp. e126-e127

Author(s):

K. Kowalczyk ◽

D. Gasecki ◽

M. Kwarciany ◽

B. Jablonski ◽

K. Narkiewicz ◽

...

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Functional Outcome ◽

Blood Pressure Variability ◽

Short Term

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The impact of systolic and diastolic blood pressure variability on mortality is age dependent: Data from the Dublin Outcome Study

European Journal of Preventive Cardiology ◽

10.1177/2047487319872572 ◽

2019 ◽

Vol 27 (4) ◽

pp. 355-364 ◽

Cited By ~ 3

Author(s):

Grzegorz Bilo ◽

Eamon Dolan ◽

Eoin O'Brien ◽

Rita Facchetti ◽

Davide Soranna ◽

...

Keyword(s):

Blood Pressure ◽

Standard Deviation ◽

Confidence Interval ◽

Diastolic Blood Pressure ◽

Cardiovascular Mortality ◽

Blood Pressure Variability ◽

Strong Predictor ◽

Outcome Study ◽

Short Term ◽

The Impact

Background Twenty-four-hour blood pressure variability (BPV) is independently related to cardiovascular outcomes, but limited and conflicting evidence is available on the relative prognostic importance of systolic and diastolic BPV. The aim of this study was to verify the hypothesis that the association of systolic and diastolic blood pressure variability over 24 h with cardiovascular mortality in untreated subjects is affected by age. Design and methods The study included 9154 untreated individuals assessed for hypertension between 1982 and 2002 in the frame of the Dublin Outcome Study, in which 24 h ambulatory blood pressure monitoring was obtained (age 54.1 ± 14.3 years, 47% males). The association of short-term systolic and diastolic blood pressure variability with cardiovascular and all-cause mortality in the entire sample and separately in younger and older age subgroups was assessed over a median follow-up period of 6.3 years. Results Diastolic BPV was directly and independently related to cardiovascular mortality (adjusted hazard ratio (adjHR) for daytime standard deviation 1.16 (95% confidence interval 1.08–1.26)) with no significant differences among age groups. Conversely, systolic BPV was independently associated with cardiovascular mortality only in younger (<50 years) subjects (adjHR for daytime standard deviation 1.72 (95% confidence interval 1.33–2.23)), superseding the predictive value of diastolic BPV in this group. Conclusions Diastolic short-term BPV independently predicts cardiovascular mortality in hypertensive subjects at all ages, while systolic BPV seems a particularly strong predictor in young adults. If confirmed, these findings might improve the understanding of the prognostic value of BPV, with new perspectives for its possible clinical application.

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