Acute‐phase blood pressure trajectories and clinical outcomes in ischemic stroke

Abstract

High blood pressure (BP) is frequent in acute ischemic stroke (IS). However, the impact of BP change patterns during acute phase on clinical outcomes is not conclusive. This study aims to investigate the association between the acute‐phase BP trajectories and clinical outcomes in IS patients with high admission BP. The cohort consisted of 316 IS patients with admission systolic BP (SBP) ≥160 mm Hg. SBP trajectories during the first 7 days after onset were characterized using a random effects model. The patients were classified into three groups based on the SBP trajectory curve parameters: sustained high SBP (T1), moderate decrease (T2), and rapid decrease in SBP (T3). Poor outcomes were defined as modified Rankin scale score ≥3 in 3 months after onset. The relationship between SBP trajectory groups and the outcome was examined in multivariable logistic regression models. The decreasing trend was greater in the favorable than in the poor outcome group (P = 0.028 for difference in linear slopes). The incidence of poor outcomes was 25.9%, 13.5%, and 9.8% in T1 (n = 54), T2 (n = 170), and T3 (n = 92) groups, respectively. Compared with T1 group, the decrease in SBP in T2 and T3 groups was significantly associated with lower risk of the poor outcome (odds ratio = 0.25, 95% confidence interval = 0.10‐0.67, P = 0.006). These findings suggest that a decrease in BP in the acute phase is predictive of favorable outcomes in IS patients. BP trajectories have a greater power to detect the association than individual BP values at one time‐point.

Acute in‐hospital blood pressure variability predicts early neurological deterioration in acute minor stroke or transient ischemic attack with steno‐occlusive arterial disease

“…To prove the association of BPV and END, we adopted a definition of END as a ≥1‐point increase in NIHSS score during the first 72 hours after admission. And, the rate of END was 32.5% in this study, which was consistent with the rates in previous studies . And also, our findings were similar to that in the Chungs' study .…”

“…And, the rate of END was 32.5% in this study, which was consistent with the rates in previous studies. [4][5][6][7][8][9][10] And also, our findings were similar to that in the Chungs' study. 16 Both studies suggested that the acute in-hospital BPV was strongly associated with the risk of having a END.…”

“…Therefore, it is of great importance to identify factors associated with END in patients with acute minor stroke or TIA due to steno‐occlusive arterial disease. Based on the previous studies, several clinical and biological factors, such as older age, the initial neurological severity, diabetes mellitus, and blood pressure, might influent the development of END in patients with general ischemic stroke . To our best known, few studies focus on patients with acute minor stroke or TIA due to steno‐occlusive arterial disease.…”

“…Based on the previous studies, several clinical and biological factors, such as older age, the initial neurological severity, diabetes mellitus, and blood pressure, might influent the development of END in patients with general ischemic stroke. [8][9][10][11] To our best known, few studies focus on patients with acute minor stroke or TIA due to steno-occlusive arterial disease.…”

“…It is well known that BP is generally very dynamic and fluctuates considerably during the first several hours of acute ischemic stroke. 10,11 A failure of cerebral autoregulation occurs when there is a narrowing or blockage in the main arteries feeding blood to the brain. And at this moment, blood flow in ischemic brain regions is mainly determined by the systemic arterial pressure.…”