Determinants of the impact of blood pressure variability on neurological outcome after acute ischaemic stroke

Abstract

IntroductionIncreased blood pressure variability (BPV) is detrimental after acute ischaemic stroke, but the interaction between BPV and neuroimaging factors that directly influence stroke outcome has not been explored.MethodsWe retrospectively reviewed inpatients from 2007 to 2014 with acute anterior circulation ischaemic stroke, CT perfusion and angiography at hospital admission, and a modified Rankin Scale (mRS) 30–365 days after stroke onset. BPV indices included SD, coefficient of variation and successive variation of the systolic blood pressure between 0 and 120 hours after admission. Ordinal logistic regression models were fitted to mRS with predictor variables of BPV indices. Models were further stratified by CT perfusion volumetric measurements, proximal vessel occlusion and collateral score.Results110 patients met the inclusion criteria. The likelihood of a 1-point rise in the mRS increased with every 10 mm Hg increase in BPV (OR for the 3 BPV indices ranged from 2.27 to 5.54), which was more pronounced in patients with larger ischaemic core volumes (OR 8.37 to 18.0) and larger hypoperfused volumes (OR 6.02 to 15.4). This association also held true for patients with larger mismatch volume, proximal vessel occlusion and good collateral vessels.ConclusionsThese results indicate that increased BPV is associated with worse neurological outcome after stroke, particularly in patients with a large lesion core volume, concurrent viable ischaemic penumbra, proximal vessel occlusion and good collaterals. This subset of patients, who are often not candidates for or fail acute stroke therapies such as intravenous tissue plasminogen activator or endovascular thrombectomy, may benefit from interventions aimed at reducing BPV.

Effect of short-term blood pressure variability on functional outcome after intra-arterial treatment in acute stroke patients with large-vessel occlusion

“…BP management and its effect on functional outcome is particularly controversial. A previous study showed that increased systolic BPV positively contributed to symptomatic intracerebral hemorrhage and death after intravenous thrombolysis [16]. However, less is known about the effect of short-term BPV after EVT on the early outcomes of AIS-LVO patients.…”

“…The mean age was 64.8±10.9 years, and 27 (37.5%) were women. The median NIHSS score at admission was 14 points [IQR, [9][10][11][12][13][14][15][16][17][18][19], while the median ASPECTS was 8 points [IQR, [7][8][9]. Of the 72 patients, 86.1% patients achieved recanalization (TICI 2b or 3).…”

The relationship between blood pressure variability and outcome in acute ischemic stroke

“…In another study, de Havenon et al examined the relationship between SD, CV, and SV of SBP measured within 120 hours after admission in 110 patients with acute anterior circulation ischemic stroke with mRS score between 30 and 365 days [55]. Higher BPV was found to be associated with worse outcome, especially in patients with larger ischemic core volumes (defined as relative cerebral blood flow < 40% and absolute arterial tissue delay > 2 s) and larger hypoperfused volumes (defined as relative mean transit time > 135%).…”

Stroke epidemiology based on experience from Krasnik county in eastern Poland

“…The relapse frequency depends on the subtype of stroke and is the highest in patients who have suffered from stroke due to embolism of cardiac origin, and in cases of a significant stenosis of the carotid arteries [27]. At the same time, high blood pressure is a high-risk factor for patients in all age groups, which further increases the risk of recurrent stroke [65,66,67].…”