Change in blood pressure variability in patients with acute ischemic stroke and its effect on early neurologic outcome

PLoS One. 2017 Dec 18;12(12):e0189216. doi: 10.1371/journal.pone.0189216. eCollection 2017.

Abstract

Background: How short-term blood pressure variability (BPV) is affected in the acute stage of ischemic stroke and whether BPV is associated with early neurologic outcomes remains unclear.

Methods: Patients who admitted for ischemic stroke within 24 h of symptom onset were consecutively identified between January 2010 and January 2015. BP profiles measured in real-time were summarized into short-term, 24-h time intervals, based on standard deviation (SD) and mean of systolic BP (SBPSD) during the first 3 days. The primary outcome was daily assessment of early neurological deterioration (END). The associations between short-term SBPSD values and the secular trend for primary outcome were examined.

Results: A total of 2,545 subjects (mean age, 67.1 ± 13.5 years old and median baseline National Institutes of Health Stroke Scale score, 3) arrived at the hospital an average of 6.1 ± 6.6 h after symptom onset. SBPSD values at day 1 (SD#D1), SD#D2, and SD#D3 were 14.4 ± 5.0, 12.5 ± 4.5, and 12.2 ± 4.6 mmHg, respectively. Multivariable analyses showed that SD#D2 was independently associated with onset of END at day 2 (adjusted odds ratio, 1.08; 95% confidence interval, 1.03-1.13), and SD#D3 was independently associated with END#D3 (1.07, 1.01-1.14), with adjustments for predetermined covariates, SBPmean, and interactions with daily SBPSD.

Conclusion: Short-term BPV changed and stabilized from the first day of ischemic stroke. Daily high BPV may be associated with neurological deterioration independent of BPV on the previous day.

MeSH terms

  • Aged
  • Blood Pressure / physiology*
  • Brain Ischemia / complications*
  • Brain Ischemia / physiopathology*
  • Female
  • Humans
  • Male
  • Stroke / complications*
  • Stroke / physiopathology*
  • Systole / physiology
  • Treatment Outcome

Grants and funding

The authors received no specific funding for this work.