Blood pressure variability at different time periods within first 24 hours after admission and outcomes of acute ischemic stroke

Abstract

This study discusses the association between blood pressure (BP) variability at different time periods within first 24 hours after admission and the functional outcome in acute ischemic stroke (AIS). We observed BP variability within first 24 hours after admission and evaluated the association between BP variability at different time periods (4 am‐8 am, 10 am‐2 pm, 4 pm‐8 pm, 10 pm‐2 am) and the functional outcome in AIS. National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) were applied to evaluate short‐ (7 days) and long‐term functional outcome. The 24 hours after admission and early morning (4 am‐8 am) systolic blood pressure (SBP) variability were associated with poor outcome at day 7 (adjusted OR = 1.567, 95% CI = 1.076‐2.282; adjusted OR = 1.507, 95% CI = 1.028‐2.209, respectively). Compared with the impact of the 24‐hour BP variability on long‐term functional outcome, the early morning SBP was proved to be a strongly independent predictor for functional outcome at 3 months (adjusted OR = 1.505, 95% CI = 1.053‐2.152), 6 months (adjusted OR = 1.560, 95% CI = 1.048‐2.226), and 12 months (adjusted OR = 1.689, 95% CI = 1.104‐2.584). The BP variability in other time period groups was shown to have no influence on functional outcome. In addition, attempts to explain early morning BP variability with baseline characteristic factors at admission found that baseline SBP is the most influential (2.71%) factor. About 95.87% of the SBP variability in early morning was unexplained. In our study, early morning SBP variability is the strongest independent predictor for functional outcome in (AIS) patients, and baseline SBP after admission should be monitored as a control indicator of early morning SBP variability in the treatment of AIS patients.

Systolic blood pressure variability within 120 hours of admission predicts the functional outcomes at discharge of patients with acute ischemic stroke

“…Studies on the short-term influence of DBP variability on the neurological outcomes of patients with AIS are inconsistent. Our results are in line with studies that uncovered that DBP variability contributes to the functional deterioration of patients with AIS [20][21][22][23], although the majority of the literature exhibit that SBP variability is a better predictor of worse neurological outcomes [11,14,15,24,25]. While a high DBP variability may impact the ventricular end-diastolic volume and the cerebral perfusion in patients with impaired cerebral blood flow autoregulation, the J-curve relationship between DBP and cardiovascular events may produce a confounding effect on stroke outcomes [26].…”

“…To our knowledge, this is the first study to evaluate BPV in patients with AIS beyond 24 hours after admission and its relationship with outcomes at discharge. Furthermore, we analyzed BPV as a continuous variable at different time intervals, whereas previous studies considered its cumulative effect by dividing patients into percentiles according to their blood pressure indices [10,11,14,29]. This approach may result in the loss of statistical power, and using a continuous covariate provides a better understanding of the impact of minute and gradual changes in BPV on the functional outcomes.…”

“…In fact, many systematic reviews and meta-analyses have associated high blood pressure levels in patients with AIS with dependency, deterioration, and death [7,8]. Regardless of the absolute systolic (SBP) and diastolic (DBP) blood pressure levels, blood pressure variability (BPV) is an independent predictor of stroke outcome [9][10][11][12][13][14][15]. This association is greater with SBP variability, while the prognostic significance of DBP variability remains uncertain [15].…”

Early Mortality of Brain Infarction Patients and Red Blood Cell Distribution Width

“…Different factors have been associated with the outcome stroke such as oxidation [17,18], inflammation [19][20][21][22], hyperglycemia [23], or alterations in brain perfusion due to blood pressure variability [24,25]. In addition, there has been found the association of RDW with oxidative stress in animal models [26], with blood TNF-alpha levels in critically ill patients [27,28], and with atrial fibrillation and its risk of complications and mortality [29][30][31].…”

Posterior reversible encephalopathy syndrome coexists with acute cerebral infarction: challenges of blood pressure management

“…Different views exist on antihypertensive therapy for acute ischemic injury, and this presents a challenge to the management of BP in PRES. Meanwhile, in the acute phase of cerebral ischemic injury, severe fluctuations of BP should be avoided; Geng et al (39) found that severe fluctuation of SBP within 24 h of onset was an independent risk factor for poor prognosis at 7 days. Manning et al (40) also proved that fluctuations of SBP within 24 h of infarction was an independent risk factor for hemorrhagic transformation.…”