Abstract
Background: The association of in-hospital blood pressure variability (BPV) with readmission or survival after acute ischemic stroke (AIS) have not been fully investigated. We evaluated the relationship between intra-individual systolic blood pressure (SBP) variability (SBPV) for the duration of hospitalization, mean SBP, maximal SBP reached and readmission-free survival, all-cause readmission, or all-cause mortality to one year after hospitalization for a new acute ischemic stroke (AIS). Methods: We measured mean SBP, maximal SBP reached, and SBPV as quartiles of standard deviations (SD) and coefficient of variation (CV) across a median of 16 SBP readings per patient, every 4 hours, for the duration of hospitalization in 862 patients (age (mean±SD) 75±15 years, 55% females) with AIS admitted from 2003 to 2018, followed-up to 2019. Results: At 1 year, readmission-free survival was 51%, readmission rate was 39%, and mortality was16%. The mean ± SD in mmHg for SBP 146±20, maximal SBP reached 163±26, SD 16±6, and CV 10±5. Adjusted hazard ratios for the highest vs. lowest quartiles of SD or CV were 1.44 (95% confidence interval 1.04 - 1.81) or 1.29 (0.94 - 1.64) for readmission-free survival; 1.29 (0.9 - 1.78) or 1.29 (0.94 - 1.78) for readmission; 1.15 (0.71 - 1.87) or 0.86 (0.55 - 1.36) for mortality. The results remained consistent with mean SBP. However, maximal SBP was inversely associate with readmission-free survival. The accompanying figure shows Kaplan-Meier survival analysis of cumulative incidence of three outcomes by quartiles of SD (upper panel) and CV (lower panel) of SBP. Conculsions: Among patients hospitalized with a new AIS, higher in-hospital SBPV was associated with no decrease in readmission-free survival or increase in rates of readmission or mortality to 1 year. We recommend less emphasis on treating blood pressure and more focus on guideline-directed high-value care for the management AIS patients.
Published Version
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