Prognostic Value of 24-H ABPM in Acute Ischemic Stroke for Short-, Medium-, and Long-Term Outcome: A Systematic Review and Meta-Analysis

Kakaletsis, Nikolaos; Ntaios, George; Milionis, Haralampos; Haidich, Anna‐Bettina; Makaritsis, Konstantinos; Savopoulos, Christos; Berge, Eivind; Hatzitolios, Apostolos

doi:10.1111/ijs.12609

Cited by 25 publications

(21 citation statements)

References 36 publications

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“…() too, noted an association between lower BP and death . Recently, a meta‐analysis of several relatively small studies (Kakaletsis et al., ) investigated the association between outcome in acute IS and BP measured by ambulatory monitoring methods during the first 24 hr of admission and found that elevated pressures predicted poor outcome, in the form of either death or poor functional outcome.…”

Section: Introductionmentioning

confidence: 99%

Acute blood pressure levels and long‐term outcome in ischemic stroke

et al. 2018

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ObjectivesElevated blood pressure (BP) is common in acute ischemic stroke, but its effect on outcome is not fully understood. We aimed to investigate the association of baseline BP and BP change within the first day after stroke with stroke severity, functional outcome, and mortality.MethodsPatients admitted to hospital with acute ischemic stroke (IS) from 15 February 2005 through 31 May 2009 were consecutively included. Acute stroke severity and functional outcome at three and twelve months were investigated using multivariate regression analysis; the association between BP and all‐cause mortality at one, three, and twelve was investigated by Cox proportional hazard regression and Kaplan–Meier survival curves.ResultsA total of 799 patients (mean age 78.4 ± 8.0, 48% men) were included. Higher decreases in systolic and mean arterial blood pressure (ΔSBP and ΔMAP) were associated with decreased 1‐month mortality (ΔSBP: hazard ratio, HR: 0.981; 95% CI: 0.968 – 0.994; p = .005), 3‐month mortality (ΔSBP: HR 0.989; 95% CI 0.981 – 0.998; p‐value .014), and twelve‐month mortality (ΔSBP: HR 0.989; 95% CI 0.982 – 0.996; p‐value .003). Stroke severity was associated with ΔMAP (B coefficient −.46, p‐value .011). Higher SBP and MAP on admission were associated with better functional outcome at three (SBP: OR 0.987; 95% CI 0.978 – 0.997; p‐value .008 ‐ MAP: OR 0.985; 95% CI 0.971 – 1; p‐value .046) and twelve (SBP: OR 0.988; 95% CI 0.979 – 0.998; p‐value .015 – MAP: OR 0.983; 95% CI 0.968 – 0.997; p‐value .02) months.ConclusionIn this elderly population, higher BP on arrival to the emergency room (ER) and decrease in BP after the patients’ arrival to the ward were associated with improved functional outcome and reduced mortality, respectively. These results may reflect a regulatory situation in which elevated initial blood pressure indicates adequate response to cerebral tissue ischemia while subsequent blood pressure decrease instead may be a consequence of partial, successful reperfusion.

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Section: Introductionmentioning

confidence: 99%

Acute blood pressure levels and long‐term outcome in ischemic stroke

et al. 2018

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“…High BP variability in the acute phase of ischemic stroke has also been reported to lead to poor outcomes because such variability during the first 72 hours of stroke onset promotes hemorrhagic transformation and increases the risk of lesion growth and recurrence 9,10 . However, a systematic review and meta-analysis found no association between BP variability during the first 24 hours of admission and stroke outcome 11 . Previous studies have explained some of these conflicting results.…”

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confidence: 98%

Increased blood pressure variability during the subacute phase of ischemic stroke is associated with poor functional outcomes at 3 months

Naito

Hosomi

Kuzume

et al. 2020

Sci Rep

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thus far, it is well known that increased blood pressure variability may exacerbate stroke outcomes. Blood pressure in the acute phase would be influenced by both reactive hypertension to stroke and intrinsic blood pressure reactivity. thus, we aimed to evaluate the association between blood pressure variability and outcomes at 3 months using ambulatory blood pressure monitoring in ischemic stroke patients in the subacute phase after reactive hypertension subsided. We retrospectively examined 626 consecutive patients with acute ischemic stroke who underwent 24-hour ambulatory blood pressure monitoring during the subacute phase of stroke (median, 9 days from onset). The variability in blood pressure was evaluated by assessing the standard deviation and coefficient of variation of systolic and diastolic blood pressure. The primary outcome was functional status at 3 months. A poor outcome was defined as a modified Rankin scale score of 3 or more and a good outcome as 2 or less. We assessed the functional outcome at 3 months in 497 patients (79.4%). The mean systolic and diastolic blood pressure levels were not associated with functional outcome. the multivariable analysis revealed that increases in the standard deviations of systolic and diastolic blood pressure, coefficient of variation of diastolic blood pressure, and morning blood pressure surge were associated with poor outcome. Blood pressure variability during the subacute phase of ischemic stroke can be a useful prognostic indicator of poor functional outcome at 3 months in patients with acute ischemic stroke.

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“…A meta-analysis of studies of acute ischemic stroke patients admitted within 24 hours of onset and undergoing ABPM within 24 hours of admission showed that both high systolic and diastolic BP levels derived from ambulatory BP monitoring were associated with poor short-, intermediate-, and long-term outcomes, but the same was not found for casual (clinic) BP measurements. 45 Additionally, in a study of 128 initial acute stroke patients who underwent ABPM within 24 hours of stroke onset and computerized tomography scans of the brain on both admission to the hospital and 5 days later, multivariate logistic regression analysis showed that each 0.1 mm Hg/minutes increase in the time rate of 24 hours SBP variation was associated with a 13.9% increased probability of presence of brain edema.…”

Section: Ambulatory Bp Monitoring In Evaluating Outcomes For Recurrenmentioning

confidence: 99%

Small Vessel Disease of the Brain and Stroke: Association with Clinic and Ambulatory Blood Pressure

Gupta¹,

White²,

Ram³

2016

Hypertension Journal

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Several potential vascular risk factors exist for the development and accumulation of small vessel disease of the brain and stroke in older people. In older people followed up for several years, we and others have reported that white matter hyperintensity lesions on magnetic resonance imaging nearly doubled in volume and were associated with alterations in neurologic function. In this article, we review blood pressure (BP) as a risk factor for the development and pathogenesis of small vessel disease and stroke in older persons. The research efforts have focused on ambulatory BP measurements, which have proven to be a stronger indicator than clinic pressures for the progression of small vessel disease in older people as well as the development of stroke. Based on relations among 24 hours systolic BP levels, the accrual of small vessel disease, and relations with cognitive function and mobility, we have designed the INFINITY trial, a novel interventional study that uses ambulatory BP to guide antihypertensive therapy addressed at improving functional decline.

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Prognostic Value of 24-H ABPM in Acute Ischemic Stroke for Short-, Medium-, and Long-Term Outcome: A Systematic Review and Meta-Analysis

Cited by 25 publications

References 36 publications

Acute blood pressure levels and long‐term outcome in ischemic stroke

Acute blood pressure levels and long‐term outcome in ischemic stroke

Increased blood pressure variability during the subacute phase of ischemic stroke is associated with poor functional outcomes at 3 months

Small Vessel Disease of the Brain and Stroke: Association with Clinic and Ambulatory Blood Pressure

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