Abstract 93: Increased Blood Pressure Variability After Acute Ischemic Stroke Increases the Risk of Death

Abstract

Introduction: Increased visit-to-visit blood pressure variability (BPV) is linked to a higher risk of incident ischemic stroke in large epidemiologic studies. Hypothesis: Increased BPV in the acute phase after ischemic stroke will be correlated with death and poor outcome. Methods: This is a secondary analysis of patients in the placebo arms of the Virtual Stroke International Stroke Trial Archive (VISTA) with 4 or 5 blood pressure readings in the 24 hours after enrollment. Our primary outcome is death and the secondary is poor outcome, defined as a modified Rankin Scale of 3 to 6, both at 90 days from enrollment. We calculated BPV using 6 statistical methodologies (Table 1) and compared the highest to lowest tercile for each measure of BPV. Results: We included 1,947 patients, of whom 907 (46.6%) were female and the mean±SD age was 69.7±12.3 years. The mean±SD time from stroke onset to study enrollment was 4.8±2.4 hours and 534 (27.4%) received intravenous tPA. Of the 1,947 patients, 332 (19%) died within 90 days and 1,125 had a poor outcome (58%). We found that higher systolic BPV had a robust association with all-cause death, but not poor outcome (Tables 1 & 2). Diastolic BPV had a less consistent association with either outcome. Conclusion: Increased BPV in the first day after acute ischemic stroke is associated with a higher risk of death within 90 days, in the VISTA database. Prospective studies can establish if this is causal or an epiphenomenon.