Day-by-Day Blood Pressure Variability Is Associated With Neurological Functional Outcome After Acute Ischemic Stroke

Abstract Background Increased blood pressure variability (BPV) might be a detrimental factor after acute ischemic stroke. Previous studies on the association between blood pressure variability in the acute ischemic stroke and neurological functional outcome have yielded inconsistent results. Purpose We aimed to investigate the impact of day-by-day blood pressure variability within 7 days of onset on neurological functional outcome at 3 months after acute ischemic stroke. Methods Total 367 patients hospitalized for ischemic stroke within 48 hours of onset were enrolled. The acute stage of ischemic stroke was defined as the time period from symptom onset to 7 days. During this period, day-by-day blood pressure variability, including standard deviation (SD) and coefficient variation (CV) were derived and compared to neurological functional outcome. A baseline severity-adjusted analysis was performed using 3-month modified Rankin Scale score as the neurological functional outcome. Unfavorable outcome was defined as mRS≥3. Results The patients with unfavorable outcome had significantly higher systolic BPV (within 7 days of onset) than those with favorable outcome (15.41±4.59 VS 13.42±3.95mmHg for SD, P<0.001; 11.54±3.23 VS 10.41±2.82 for CV, P=0.001). Multivariable logistic regression analysis revealed that Systolic BPV was significantly and independently associated with the 3-month neurological functional outcome (odds ratio [OR] = 1.15, 95% confidence interval [CI]: 1.07–1.22, P<0.001 for SD; OR=1.15, 95% CI: 1.06–1.26, P=0.001 for CV). In addition, After adjustment for multiple confounding factors, including age, gender, risk factors, stroke features, baseline severity, recanalized therapy, hemorrhagic transformation, pulmonary infection, white blood cell, estimated Glomerular Filtration Rate and mean BP, day-by-day BP variability was significantly correlated with an unfavorable outcome in the top versus bottom quartile of systolic BP variability (OR=3.33, 95% CI: 1.41–7.85, P=0.006 for SD; OR=2.27, 95% CI: 1.04–4.94, P=0.037 for CV) during 3-month follow-up. Similar trends were also observed for diastolic BP variability. More importantly, incorporating SD of systolic BP into the conventional prediction model significantly increased the AUC for prediction of 3-month unfavorable outcome after acute ischemic stroke (0.84 vs 0.86; P=0.041). Conclusions Increased day-by-day blood pressure variability of systolic or diastolic BP in the acute ischemic stroke was associated with higher risk for unfavorable outcome at 3 months independent of mean blood pressure. Combining SD of systolic BP with conventional risk factors could thus improve the prediction of unfavorable outcome. Funding Acknowledgement Type of funding source: None

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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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