Blood Pressure Variability in Acute Ischemic Stroke: The Role of Early Recanalization

Martins, Andrea; Sargento-Freitas, João; Jesus‐Ribeiro, Joana; Correia, Inês; Cardoso, Leila A.; Gomes, João Pedro Perez; Gonçalves, Mariana; Costa, Rui; Silva, Fernando; Galego, Orlando; Nunes, César; Beato-Coelho, José; Varela, Ricardo; Machado, Carlos; Rodrigues, Bruno; Santo, Gustavo; Cunha, Luı́s

doi:10.1159/000492627

Cited by 12 publications

(7 citation statements)

References 13 publications

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“…In patients after IVT, BP changes were independently associated not only with outcome, but also with sICH and death [62,71]. Some studies have demonstrated that the impact of BPV on outcome varied depending on the recanalisation status, with a significant association observed only in the non-recanalised group [56,74]. Similar results have been achieved in groups of patients after EVT, although an association between BPV and sICH is lacking (Tab.…”

Section: Blood Pressure Variabilitymentioning

confidence: 58%

Ambiguities in blood pressure management in acute ischaemic stroke

Kamieniarz-Mędrygał¹,

Kaźmierski

2022

Neurol Neurochir Pol.

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Introduction: Blood pressure management in acute ischaemic stroke is crucial. Here we highlight uncertainties surrounding haemodynamic management in acute ischaemic stroke on the basis of current guidelines and the data available from recent studies. This review provides practical treatment options and suggestions for future research. State of the art:The U-shaped relationship between baseline blood pressure value and patients' functional outcome or death is well established. Nonetheless, there is scant evidence for the benefits of early pharmacological intervention. Current guidelines differentiate blood pressure targets on the basis of implemented reperfusion treatment and allow blood pressure reduction in certain clinical situations. However, there is a substantial lack of evidence to guide management during acute stroke. Clinical implications:Taking into account several aspects of blood pressure management can improve stroke care, although they are not included in current guidelines. To make an optimal decision as to whether to intervene regarding blood pressure, it is important to consider dehydration, recanalisation status, blood pressure variability, and autoregulation state as measured by novel imaging techniques.Future directions: Further trials considering patient-specific factors with the use of continuous monitoring of blood pressure, as well as neurovascular imaging, are needed to resolve the current ambiguities.

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Section: Blood Pressure Variabilitymentioning

confidence: 58%

Ambiguities in blood pressure management in acute ischaemic stroke

Kamieniarz-Mędrygał¹,

Kaźmierski

2022

Neurol Neurochir Pol.

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“…This association was more evident in studies involving patients after reperfusion therapies 12 , 31 , 32 . Some studies found that BPV is associated with the post-stroke outcome only in those patients, who underwent thrombolysis treatment and who did not achieve vessel recanalization, based on imaging examination 30 , 33 . This led to the view that in patients with successful recanalization increased BPV is less of a concern.…”

Section: Discussionmentioning

confidence: 99%

Significance of pulse pressure variability in predicting functional outcome in acute ischemic stroke: a retrospective, single-center, observational cohort study

Kamieniarz-Mędrygał

Kaźmierski

2023

Sci Rep

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This study aimed to determine the association between pulse pressure variability (PPV) and short- and long-term outcomes of acute ischemic stroke (AIS) patients. We studied 203 tertiary stroke center patients with AIS. PPV during 72 h after admission was analyzed using different variability parameters including standard deviation (SD). Patients’ outcome was assessed after 30 and 90 days post-stroke with modified Rankin Scale. The association between PPV and outcome was investigated using logistic regression analysis with adjustment for potential confounders. The predictive significance of PPV parameters was determined using area under the curve (AUC) of receiver operating characteristics. In the unadjusted logistic regression analysis, all PPV indicators were independently associated with unfavorable outcome at 30 days (i.a. Odds ratio (OR) = 4.817, 95%CI 2.283–10.162 per 10 mmHg increase in SD, p = 0.000) and 90 days (i.a. OR = 4.248, 95%CI 2.044–8.831 per 10 mmHg increase in SD, p = 0.000). After adjustment for confounders, ORs for all PPV indicators remained statistically significant. On the basis of AUC values, all PPV parameters were found relevant outcome predictors (p < 0.01). In conclusion, elevated PPV during first 72 h after admission due to AIS is associated with unfavorable outcome at 30 and 90 days, independent of mean blood pressure levels.

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“…Sixth, there is conflicting evidence of the effect of recanalization status on the predictive significance of BPV. Although some studies only find an effect of BPV in patients without successful recanalization [ 1 , 24 , 31 ], others find the exact opposite result [ 6 , 11 ]. In our population, 94% of the occluded vessels were successfully recanalized, which made an analysis based on revascularization status impossible.…”

Section: Discussionmentioning

confidence: 99%

Blood Pressure Variability Indices for Outcome Prediction After Thrombectomy in Stroke by Using High-Resolution Data

et al. 2022

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Background Blood pressure variability (BPV) is associated with outcome after endovascular thrombectomy in acute large vessel occlusion stroke. We aimed to provide the optimal sampling frequency and BPV index for outcome prediction by using high-resolution blood pressure (BP) data. Methods Patient characteristics, 3-month outcome, and BP values measured intraarterially at 1 Hz for up to 24 h were extracted from 34 patients treated at a tertiary care center neurocritical care unit. Outcome was dichotomized (modified Rankin Scale 0–2, favorable, and 3–6, unfavorable) and associated with systolic BPV (as calculated by using standard deviation, coefficient of variation, averaged real variability, successive variation, number of trend changes, and a spectral approach using the power of specific BP frequencies). BP values were downsampled by either averaging or omitting all BP values within each prespecified time bin to compare the different sampling rates. Results Out of 34 patients (age 72 ± 12.7 years, 67.6% men), 10 (29.4%) achieved a favorable functional outcome and 24 (70.6%) had an unfavorable functional outcome at 3 months. No group differences were found in mean absolute systolic BP (SBP) (130 ± 18 mm Hg, p = 0.82) and diastolic BP (DBP) (59 ± 10 mm Hg, p = 1.00) during the monitoring time. BPV only reached predictive significance when using successive variation extracted from downsampled (averaged over 5 min) SBP data (median 4.8 mm Hg [range 3.8–7.1]) in patients with favorable versus 7.1 mmHg [range 5.5–9.7] in those with unfavorable outcome, area under the curve = 0.74 [confidence interval (CI) 0.57–0.85; p = 0.031], or the power of midrange frequencies between 1/20 and 1/5 min [area under the curve = 0.75 (CI 0.59–0.86), p = 0.020]. Conclusions Using high-resolution BP data of 1 Hz, downsampling by averaging all BP values within 5-min intervals is essential to find relevant differences in systolic BPV, as noise can be avoided (confirmed by the significance of the power of midrange frequencies). These results demonstrate how high-resolution BP data can be processed for effective outcome prediction.

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Blood Pressure Variability in Acute Ischemic Stroke: The Role of Early Recanalization

Cited by 12 publications

References 13 publications

Ambiguities in blood pressure management in acute ischaemic stroke

Ambiguities in blood pressure management in acute ischaemic stroke

Significance of pulse pressure variability in predicting functional outcome in acute ischemic stroke: a retrospective, single-center, observational cohort study

Blood Pressure Variability Indices for Outcome Prediction After Thrombectomy in Stroke by Using High-Resolution Data

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