Effects of 24-Hour Blood Pressure and Heart Rate Recorded With Ambulatory Blood Pressure Monitoring on Recovery From Acute Ischemic Stroke

Tomii, Yasushi; Toyoda, Kazunori; Suzuki, Riéko; Naganuma, Masaki; Fujinami, Jun; Yokota, Chiaki; Minematsu, Kazuo

doi:10.1161/strokeaha.111.628586

Cited by 54 publications

(52 citation statements)

References 43 publications

(32 reference statements)

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“…5 Similarly, hour-to-hour BP variability during acute stroke also seems to predict stroke outcomes. 6 The present substudy of the Stroke Acute Management with Urgent Risk-factor Assessment and Improvement (SAMURAI) rt-PA Registry investigates associations between early BP variability during this period and outcomes of thrombolysis.…”

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confidence: 99%

Impact of Early Blood Pressure Variability on Stroke Outcomes After Thrombolysis

Endo

Kario

Koga

et al. 2013

Stroke

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Background and Purpose— The present study determines associations between early blood pressure (BP) variability and stroke outcomes after intravenous thrombolysis. Methods— In 527 stroke patients receiving intravenous alteplase (0.6 mg/kg), BP was measured 8 times within the first 25 hours. BP variability was determined as ΔBP (maximum-minimum), standard deviation (SD), coefficient of variation, and successive variation. Results— The systolic BP course was lower among patients with modified Rankin Scale (mRS) 0 to 1 than those without ( P <0.001). Most of systolic BP variability profiles were significantly associated with outcomes. Adjusted odds ratios (95% confidence interval) per 10 mm Hg (or 10% for coefficient of variation) on symptomatic intracerebral hemorrhage were as follows: ΔBP, 1.33 (1.08–1.66); SD, 2.52 (1.26–5.12); coefficient of variation, 3.15 (1.12–8.84); and successive variation, 1.82 (1.04–3.10). The respective values were 0.88 (0.77–0.99), 0.73 (0.48–1.09), 0.77 (0.43–1.34), and 0.76 (0.56–1.03) for 3-month mRS 0 to 1; and 1.40 (1.14–1.75), 2.85 (1.47–5.65), 4.67 (1.78–12.6), and 1.99 (1.20–3.25) for death. Initial BP values before thrombolysis were not associated with any outcomes. Conclusions— Early systolic BP variability was positively associated with symptomatic intracerebral hemorrhage and death after intravenous thrombolysis.

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confidence: 99%

Impact of Early Blood Pressure Variability on Stroke Outcomes After Thrombolysis

Endo

Kario

Koga

et al. 2013

Stroke

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“…As the INTERACT database only reports 90-day outcomes, we cannot make any conclusions about long-term mortality and morbidity. Although we recognize that there are several previous studies that showed significant association between heart rate variability (which may be a surrogate for an unfavorable sympathetic dysfunction) and clinical outcomes, 22,28,29 we were unable to analyze heart rate changes after admission because of lack of data. The use of admission heart rate may present some inevitable confounding factors, such as instrumental error from different batches of ECG monitor, discrepancy from reading of heart rate fluctuation, and the emotional status of patients at the point of measurement.…”

Section: Strokementioning

confidence: 94%

“…5,22 Higher heart rate might reflect patient distress and could be associated with other parameters such as higher and unstable blood pressure that have been reported to be related to hematoma growth during the clinical course. 23,24 In contrast to the main analyses, our subgroup analyses of patients with available 24-hour CT data (both with and without adjustment for hematoma growth) showed nonsignificant association between heart rate and 90-day mRS score.…”

Section: Figurementioning

confidence: 99%

Admission Heart Rate Predicts Poor Outcomes in Acute Intracerebral Hemorrhage

Qiu

Sato

Zheng

et al. 2016

Stroke

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Background and Purpose-Faster heart rate predicts higher mortality in coronary heart disease and acute ischemic stroke, but its prognostic significance in intracerebral hemorrhage remains uncertain. We aimed to determine the effect of admission heart rate on clinical and imaging outcomes in patients with intracerebral hemorrhage. Methods-A post hoc pooled analysis of the pilot and main phases of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT 1 and 2). Clinical outcomes were mortality and modified Rankin Scale score at 90 days; and imaging outcome was absolute growth in hematoma volume during the initial 24 hours. Patients were divided into 4 categories according to baseline heart rate (<65, 65-74, 75-84, and ≥85 bpm) and analyzed using multivariable adjusted models with the lowest heart rate group as the reference. Results-Of 3185 patients with available data, higher admission heart rate was associated with both mortality and worse modified Rankin Scale score: adjusted hazard ratio for heart rate (≥85 versus <65 bpm) 1.50 (95% confidence interval, 1.07-2.11) and adjusted odds ratio 1.33 (95% confidence interval, 1.08-1.63), respectively (both P-trend <0.05). There was no significant relationship between heart rate and absolute growth in hematoma volume (P-trend, 0.196). Conclusions-Higher

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“…Increased PP above a population norm has been associated with inferior outcomes in AIS [7] [8] [9] [10] [11], especially when PP exceeds 70 mmHg [7]. With the varying components of BP and the diversity of findings among the clinical trials of BP in AIS, the optimal approach to BP management in AIS remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Interaction between Antihypertensive Therapy Class and Pulse Pressure on Outcomes Following Acute Ischemic Stroke

Lavelle¹,

Mathew²,

Arora³

et al. 2017

IJCM

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Goal: The effect of pulse pressure and interactions with type of antihypertensive therapy on mortality after acute ischemic stroke has not been previously evaluated. Materials and Methods: A retrospective cohort study was conducted to evaluate the independent and interactive effects of pulse pressure and antihypertensive class (specifically angiotensin converting enzyme inhibitor/angiotensin type 1 receptor blocker, or beta blocker) on mortality following acute ischemic stroke. Findings/Conclusions: 343 patients were identified with 49 months of follow-up. Baseline pulse pressure was 64 mmHg and age was 66.5 years. Patients were divided at a pulse pressure of 70. Patients with pulse pressure ≥ 70 were older (p < 0.001) and had higher comorbid vascular burden (p = 0.031) than those with pulse pressure < 70. Pulse pressure did not remain a significant predictor of follow-up mortality after adjustment for baseline comorbidities. Angiotensin converting enzyme inhibitor/angiotensin type 1 receptor blocker based therapy was associated with lower follow-up mortality when beta blocker was not used in pulse pressure < 70 group (odds ratio 0.07, 95% confidence interval 0.01 -0.48). Prospective analysis will be needed to confirm the protective effect of angiotensin converting enzyme inhibitor/angiotensin type 1 receptor blocker based on pulse pressure in acute ischemic stroke.

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Effects of 24-Hour Blood Pressure and Heart Rate Recorded With Ambulatory Blood Pressure Monitoring on Recovery From Acute Ischemic Stroke

Cited by 54 publications

References 43 publications

Impact of Early Blood Pressure Variability on Stroke Outcomes After Thrombolysis

Impact of Early Blood Pressure Variability on Stroke Outcomes After Thrombolysis

Admission Heart Rate Predicts Poor Outcomes in Acute Intracerebral Hemorrhage

Interaction between Antihypertensive Therapy Class and Pulse Pressure on Outcomes Following Acute Ischemic Stroke

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