Abstract TMP55: Post-stroke Blood Pressure Variability In The Acute Phase Is Associated With Pre-stroke Blood Pressure Variability In Patients Undergoing Mechanical Thrombectomy

Abstract

Introduction: High blood pressure variability (BPV) after endovascular thrombectomy is associated with post-stroke complications and poor neurological outcomes. However, whether BPV is an epiphenomenon of the stroke itself or causally related to the outcome remains unknown. Objective: In this study we aimed to evaluate if a relationship exists between pre-and post-stroke BPV in patients with large vessel occlusions (LVO). Methods: From our prospective stroke registry, we identified patients who had an anterior circulation LVO, underwent EVT, and had at least three blood pressure measurements recorded in the electronic medical record in the six months prior to their stroke admission. All patients had repeated time-stamped blood pressure data recorded for the first 72 hours after thrombectomy. Using the standard deviation of systolic BP, we calculated BPV for each patient and separated patients into tertiles based on their post-EVT BPV. The relationship between pre-stroke BPV and post-EVT BPV was analyzed using an ordinal logistic regression and Spearman’s rank correlation analysis. Results: Two hundred fifty-two patients were included in our analysis (mean age 70±16.2 years, mean admission NIHSS 15±7, median pre-stroke BP measurements 14.5 (IQR 5.0-55.8)). Pre-stroke BPV gradually increased for patients with higher post-EVT BPV tertiles (tertile 1 = 13.2(±5.2) mmHg, tertile 2 = 15.0(±5.5) mmHg, tertile 3 = 16.7(±7.0) mmHg, p=0.001). A positive correlation was observed between pre-stroke BPV and post-EVT BPV (p<0.001, R=0.21). After adjusting for age and admission NIHSS, pre-stroke BPV was significantly associated with post-EVT BPV tertile membership (OR 1.37, 95% CI 1.02-1.86, p=0.039). Conclusion: High pre-stroke BPV is correlated with high post-EVT BPV. Although larger, prospective studies are needed to provide definitive evidence of this relationship, our work suggests that high post-EVT BPV may be related to an underlying biological phenomenon and not merely a consequence of the stroke itself. Individuals with high BPV may benefit from more intensive blood pressure management in the acute phase after EVT.