Abstract TP370: Increased Blood Pressure Variability During the Subacute Phase is Associated With 3-month Functional Poor Outcome in Patients With Acute Ischemic Stroke

Abstract

Background: The increased blood pressure (BP) variability may influence on the stroke outcome. However, in the acute phase of large stroke, reactive hypertension would occur and sustain for a few days. Therefore, in this phase, it is difficult to understand a cause of BP variability whether it is from reactive hypertension or original blood pressure reactivity. Thus, we aimed to evaluate the association of BP variability using ambulatory blood pressure monitoring (ABPM) in the subacute phase of ischemic stroke, when restoration from reactive hypertension can be observed, with 3-month outcomes. Method: We retrospectively enrolled a consecutive series of 840 patients hospitalized for acute ischemic stroke (55.2% males, age: 76 ± 12 years) performing 24-hour ABPM during the subacute phase of stroke (median 9 days from onset). Variability in BP was evaluated with the standard deviation (SD) and with the coefficient of variation (CV) of systolic (SBP) and diastolic BP (DBP). The primary outcome was evaluated from the 3-month functional status: poor outcome as a modified Rankin Scale score of 3 or more and good outcome as 2 or less. Results: Patients with dipper, non-dipper and riser type were 11.4%, 50.5%, and 38.1%, respectively among the total enrolled cohort. Of these, 651 patients (77.5 %) were assessed for the functional outcomes at 3 months. The rates of patients with poor functional outcome were higher in patients with non-dipper or riser type than in the dipper type (47.7%, 57.1%, and 35.1%, respectively). The mean level of SBP and DBP were not associated with functional outcome. The variability of SBP and DBP was significantly associated with poor functional outcome in univariate analysis. After adjusting for age, sex and initial stroke severity, one increase of SD value (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.03 to 1.13, P<0.001), CV value (OR 1.06, 95% CI 1.01 to 1.12, P = 0.02) for SBP, and SD value (OR 1.07, 95% CI 1.04 to 1.10, P<0.001), CV value (OR 1.05, 95% CI 1.02 to 1.08, P<0.001) for DBP were independently associated with poor outcome. Conclusion: The variability of BP in the subacute phase of ischemic stroke is expected to be a useful prognostic factor of a 3-month functional outcome.