Admission Systolic Blood Pressure and Outcomes After Endovascular Thrombectomy: An International EVA-TRISP Cohort Study.

The relationship between circadian blood pressure (BP) variations and the extent of subclinical cardiac organ damage is still debated. In a general population, we investigated the association of night-to-day BP fall, as well as nocturnal BP level (mean and lowest values), with left ventricular (LV) hypertrophy and the value of both BP parameters in predicting new-onset LV hypertrophy. Office BP, 24-hour ambulatory BP values, and laboratory investigations were assessed on entry in 1682 subjects (50.2% men; mean age, 50.2±13.7 years) of the Pressioni Arteriose Monitorate E Loro Associazioni. Echocardiographic LV mass was measured at the initial evaluation and 10 years later. Multiple regression analyses, including daytime systolic BP (SBP), age, sex, and body mass index, showed that the lowest SBP level and the extent of nocturnal SBP decline were independently related to baseline LV mass. After adjustment for several confounders, both mean nocturnal SBP (relative risk for each 10-mm Hg increase in SBP, 1.15; 95% confidence interval, 1.01–1.23; P <0.0001) and the lowest SBP level (relative risk for each 10-mm Hg increase in SBP, 1.10; 95% confidence interval, 1.02–1.19; P =0.01) were independent predictors of new-onset LV hypertrophy. This was not the case for the magnitude of nighttime SBP fall (hazard ratio for each 10% decrease in SBP, 0.91; 95% confidence interval, 0.80–1.04; P =0.18). In a general population, nighttime BP level rather than the nocturnal BP decline may be regarded as a reliable parameter for predicting the development of LV hypertrophy in subjects with normal LV mass. This finding may have important implications for optimizing cardiovascular prevention in the general population.

Association of Blood Pressure Increases During Hemodialysis With 2-Year Mortality in Incident Hemodialysis Patients: A Secondary Analysis of the Dialysis Morbidity and Mortality Wave 2 Study

Admission systolic blood pressure and effect of endovascular treatment in patients with ischaemic stroke: an individual patient data meta-analysis

To explore whether maternal baseline systolic blood pressure (SBP) and diastolic blood pressure (DBP) affect pregnancy outcomes particularly in normotensive women (SBP, 90-139 mm Hg; DBP, 60-89 mm Hg) and hypertensive women undergoing invitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Retrospective cohort study. Maximum care hospital for reproductive medicine. This study included 73,462 patients who underwent IVF/ICSI at the Reproductive and Genetic Hospital of CITIC-Xiangya between January 1, 2016, and November 30, 2020, selected on the basis of pre-established criteria. Analysis was limited to the first transfer cycle of the first stimulation cycle. Baseline SBP and DBP. The primary outcome focused on the live birth rate (LBR), with the secondary outcomes including clinical pregnancy rate, ectopic pregnancy rate, first-trimester miscarriage rate, second- or third-trimester fetal loss, and delivery/neonatal/maternal outcomes. Analytic methods included Poisson regression, linear regression, linear mixed-effect model, and restricted cubic spline analysis as appropriate. For normotensive women, a 10-mm Hg increase in SBP was associated with an adjusted relative risk of 0.988 (95% confidence interval, 0.981-0.995) for live birth likelihood. However, DBP was not significantly associated with LBR after adjustments. The secondary outcomes indicated that increases in SBP and DBP were associated with higher risks of first-trimester miscarriage, gestational diabetes mellitus, and gestational hypertension in the normotensive subset. Sensitivity analyses confirmed these associations between SBP/DBP and LBR, consistent with the main findings even under stricter guidelines and after adjusting for multiple confounders. Subgroup analyses showed variation in the impact of blood pressure on LBR across different demographics and conditions. Consistent with earlier studies on blood pressure and birth outcomes, we found a 10-mm Hg increase in SBP was associated with a 5.4% (adjusted relative risk per 10 mm Hg, 0.946; 95% confidence interval, 0.907-0.986) reduction in LBR in the hypertensive subgroup. Systolic blood pressure impacted LBR outcomes in normotensive women who underwent IVF/ICSI, which suggests the need for reconsidering blood pressure management guidelines for reproductive-age women, focusing on reproductive health in addition to cardiovascular risk.

Kidney volume, blood pressure, and albuminuria: findings in an Australian aboriginal community

High blood pressure (BP) is frequent in acute ischemic stroke (IS). However, the impact of BP change patterns during acute phase on clinical outcomes is not conclusive. This study aims to investigate the association between the acute-phase BP trajectories and clinical outcomes in IS patients with high admission BP. The cohort consisted of 316 IS patients with admission systolic BP (SBP) ≥160mmHg. SBP trajectories during the first 7days after onset were characterized using a random effects model. The patients were classified into three groups based on the SBP trajectory curve parameters: sustained high SBP (T1), moderate decrease (T2), and rapid decrease in SBP (T3). Poor outcomes were defined as modified Rankin scale score ≥3 in 3months after onset. The relationship between SBP trajectory groups and the outcome was examined in multivariable logistic regression models. The decreasing trend was greater in the favorable than in the poor outcome group (P=0.028 for difference in linear slopes). The incidence of poor outcomes was 25.9%, 13.5%, and 9.8% in T1 (n=54), T2 (n=170), and T3 (n=92) groups, respectively. Compared with T1 group, the decrease in SBP in T2 and T3 groups was significantly associated with lower risk of the poor outcome (odds ratio=0.25, 95% confidence interval=0.10-0.67, P=0.006). These findings suggest that a decrease in BP in the acute phase is predictive of favorable outcomes in IS patients. BP trajectories have a greater power to detect the association than individual BP values at one time-point.

Background The admission systolic blood pressure (SBP) recorded at the emergency department is typically elevated and tends to decrease, while various degrees of blood pressure variability (BPV) remain. Whether admission SBP or mean SBP and BPV from resting beat-to-beat measurements are better associated with short term outcome remains unknown. Methods We conducted a prospective study, including adults acutely admitted to the emergency department at a larger Danish tertiary care Hospital in Denmark from 2019 to 2023. We measured blood pressure (BP) at admission and beat-to-beat BP and BPV during 10-minute rest. We defined BPV as the standard deviation from the mean of the beat-to-beat SBP measurements. Primary outcome was defined as 3-month all-cause mortality or readmission, and secondary outcome as 3-month cardiovascular mortality or readmission for cardiovascular disease. Results Among 951 patients included, mean age was 64 (Standard deviation; 17) with 44% female. During 3-month follow-up, 284 (30%) patients met a primary outcome and 69 (7,2%) a secondary outcome. In Cox models adjusted for relevant comorbidities, admission SBP, but neither mean SBP or BPV, was significantly associated with primary outcome (Hazard ratio (HR) 0.971, 95% confidence interval (CI) 0.948-0.995, p=0.017) for each 5 mmHg increase in SBP. When exploring both extremes of upper and lower quartiles, BPV >10 mmHg was associated with increased cardiovascular events (HR 2.019, 95% CI 1.142-3.569, p=0.016) in the adjusted Cox model. Conclusion In this study, low admission SBP was associated with all-cause readmissions and death, while BPV above 10 mmHg was associated with 3-month risk of cardiovascular events.

The admission systolic blood pressure (SBP) recorded at the emergency department is typically elevated and tends to decrease, while various degrees of blood pressure variability (BPV) remain. Whether admission SBP or mean SBP and BPV from resting beat-to-beat measurements are better associated with short-term outcome remains unknown. We conducted a prospective study, including adults acutely admitted to the emergency department at a larger Danish tertiary care Hospital in Copenhagen, Denmark from 2019 to 2023. We measured blood pressure (BP) at admission and beat-to-beat BP and BPV during 10-minute rest. We defined BPV as the standard deviation from the mean of the beat-to-beat SBP measurements. Primary outcome was defined as 3-month all-cause mortality or readmission, and secondary outcome as 3-month cardiovascular mortality or readmission for cardiovascular disease. Among 951 patients included, mean age was 64 (standard deviation; 17) with 44% women. During 3-month follow-up, 284 (30%) patients met a primary outcome and 69 (7,2%) a secondary outcome. In adjusted Cox models, admission SBP, but neither mean SBP or BPV, was significantly associated with primary outcome [hazard ratio 0.971, 95% confidence interval (CI) 0.948-0.995, P = 0.017] for each 5 mmHg increase in SBP. When exploring both extremes of upper and lower quartiles, BPV greater than 10 mmHg was associated with increased cardiovascular events (hazard ratio 2.019, 95% CI 1.142-3.569, P = 0.016). In this study, low admission SBP was associated with all-cause readmissions and mortality, while BPV above 10 mmHg was associated with 3-month risk of cardiovascular events.

The association between obesity and hypertension is well established. Weight loss has been shown to reduce blood pressure (BP) among hypertensive patients. Nevertheless, the effect of weight changes on BP in normotensive individuals is less clear. The author explored the association between non‐interventional weight alterations and BP changes in a large cohort of normotensive adults. This is a retrospective analysis of normotensive individuals, between 2010 and 2018. All weight changes were non‐interventional. Body mass index (BMI) and BP were measured annually. Patients were divided according to the change in BMI between visits: reduction of more than 5% ("large reduction"), between 2.5% and 5% ("moderate reduction"), reduction of <2.5% or elevation of <2.5% ("unchanged"), elevation between 2.5% and 5% ("moderate increase"), and elevation of more than 5% ("large increase"). The primary outcome was the change in systolic BP (SBP) between the visits. The final analysis included 8723 individuals. 20% of the patients reduced their BMI by at least 2.5% and 24.5% increased their BMI by more than 2.5%. "High reduction" inferred an absolute decrease of 3.6 mmHg in SBP, while "large increase" resulted in an absolute increase of 1.9 mmHg in SBP. The proportion of individuals with at least 10 mmHg decrease in SBP progressively declined according to the relative decrease in BMI, and the proportion of patients with at least 10 mmHg increase in SBP progressively increased. This effect was more pronounced in individuals with higher baseline SBP. Among normotensive adults, modest non‐interventional weight changes may have significant effects on SBP.

Objective: The association between obesity and hypertension is well established. Weight loss has been shown to reduce blood pressure (BP) among hypertensive patients. Nevertheless, the effect of weight changes on BP in normotensive individuals is less clear. We explored the association between non-interventional weight alterations and BP changes in a large cohort of normotensive adults. Design and method: a retrospective analysis of normotensive individuals, between 2010–2018. All weight changes were non-interventional. Body mass index (BMI) and BP were measured annually. Patients were divided according to the change in BMI between visits: reduction of more than 5% (’large reduction’), between 2.5–5% (’moderate reduction’), reduction of less than 2.5% or elevation of less than 2.5% (’unchanged’), elevation between 2.5–5% (’moderate increase’) and elevation of more than 5% (’large increase’). The primary outcome was the change in systolic BP (SBP) between the visits. Results: The final analysis included 8,723 individuals. 20% of the subjects reduced their BMI by at least 2.5% and 24.5% increased their BMI by more than 2.5%. ’High reduction’ inferred an absolute decrease of 3.6 mmHg in SBP, while ’large increase’ resulted in an absolute increase of 1.9 mmHg in SBP. The proportion of individuals with at least 10 mmHg decrease in SBP progressively declined according to the relative decrease in BMI, and the proportion of patients with at least 10 mmHg increase in SBP progressively increased. This effect was more pronounced in individuals with higher baseline SBP. Conclusions: Among normotensive adults, modest non-interventional weight changes may have significant effects on SBP.

Hypertension as a Risk Factor for Ischemic Stroke in Women

Background: Despite recent advances in stroke care, endovascular thrombectomy (EVT) availability remains concentrated in metropolitan areas, and many patients with large vessel occlusions (LVO) strokes require interhospital transfer to receive EVT. It remains unclear how changes in blood pressure metrics in transit influence radiographic and clinical evolution. Methods: This was a retrospective study of LVO patients transferred to a comprehensive stroke center (CSC) for EVT within 1.5 to 6 hours of initial imaging. Clinical and radiographic data were collected at outside hospital and at CSC. Blood pressure (BP) metrics, including systolic blood pressure (SBP) and mean arterial pressure (MAP), were collected at the time of initial stroke imaging and upon arrival at CSC. BP changes were calculated as percentage deviations from initial measurements compared to measurements at CSC arrival. Primary outcomes were Alberta Stroke Programme Early Computed Tomography Score (ASPECTS) and NIH Stroke Scale (NIHSS) change from initial diagnosis to CSC arrival, adjusted for demographics, time from last known well, comorbidities, laboratory values, initial ASPECTS, initial NIHSS, intravenous thrombolysis (IVT) administration, transit time, and initial BP using multivariable linear regression analyses. Results: A total of 335 patients were included. Mean age was 68.5 years, 49.9% were male, 47.8% received IVT, and mean transit time was 199 minutes. Mean presenting SBP was 151.3 mmHg, and mean MAP was 107.1 mmHg. Mean ASPECTS decay was 2, and mean NIH stroke scale deterioration was 1.1. In multivariable regression analysis, change in SBP during transit was independently and significantly associated with ASPECTS decay (-0.48 per 20% decrease in SBP, p=0.003) and numerically associated with NIHSS worsening (+0.73 per 20% decrease in SBP, p=0.079). Similarly, change in MAP was associated with ASPECTS decay (-0.35 per 20% decrease in MAP, p=0.019) and NIHSS worsening (+0.82 per 20% decrease in SBP, p=0.030). Conclusions: Blood pressure changes during interhospital transfer for EVT are significantly associated with radiographic and clinical evolution of LVO stroke. BP decreases were associated with ASPECTS decay and NIHSS worsening. These findings have significant implications for BP management during EVT transfer, as well as clinical appropriateness of procedures such as endotracheal intubation and intravenous thrombolysis administration.

Intradialytic hypotension and hypertension are both independently associated with mortality among persons with end-stage renal disease on hemodialysis. Endothelial dysfunction and arterial stiffness are two possible mechanisms underlying these phenomena, but their association with hemodynamic instability during dialysis has not been evaluated. Thirty patients were recruited from chronic dialysis units at San Francisco General Hospital and San Francisco Veterans Affairs Medical Center. Endothelial dysfunction was assessed with flow-mediated dilation of the brachial artery after upper arm occlusion. Arterial stiffness was assessed using carotid-femoral pulse wave velocity measured by tonometry. Intradialytic hypotension and hypertension were defined as the average decrease in systolic blood pressure (SBP) over 1 week, as well as the frequency over 1 month of hypotension or hypertension. Every 5% decrease in flow-mediated dilation was associated with a 7.5 mmHg decrease in SBP after adjustment for phosphorus, body mass index, atherosclerosis, and ultrafiltration (P=0.02). Every 5 m/s increase in pulse wave velocity was associated with an 8 mmHg increase in SBP after adjustment for predialysis SBP and ultrafiltration (P=0.03). Over 1 month, every 5% lower flow-mediated dilation was associated with a 10% higher frequency of hypotension (P=0.09), and every 5 m/s increase in pulse wave velocity was associated with an 15% higher frequency of hypertension (P=0.02). In a cross-sectional analysis of 30 dialysis patients, endothelial dysfunction and arterial stiffness were independently associated with intradialytic hypotension and intradialytic hypertension, respectively. Elucidating these potential mechanisms of hemodynamic instability during dialysis may facilitate development of treatment strategies specific to this pathophysiology.

The purpose of this study was to determine at which time points acute blood pressure (BP) was associated with neurological deterioration at 3 weeks in patients with ischemic stroke as a whole and in patients with different subtypes. BP was measured every 6 hours for the first 36 hours of emergent hospitalization in 565 consecutive patients (347 men, 70+/-11 years in age) presenting within 24 hours of an acute ischemic stroke. Neurological deterioration was defined as a >or=2-point increase in the National Institutes of Health stroke scale (NIHSS) score at 3 weeks compared to the admission score. At 3 weeks, 64 patients (11.3%) had deteriorated neurologically. For the group as a whole, high systolic BP (SBP) values measured at 12, 18, 24, and 36 hours postadmission were independently related to neurological deterioration after adjustment for age, sex, and known predictors, including admission NIHSS score, admission blood glucose level, and large infarct size. At 24 hours, the odds of neurological deterioration increased by 20% per 10-mm Hg increase in SBP. For cardioembolic stroke patients, high SBP values measured at 12 through 36 hours were independently related to neurological deterioration after multivariate adjustment. For patients having stroke other than cardioembolism, no SBP values at any time point were related to neurological deterioration. Acute SBP values between 12 and 36 hours postadmission, but not those on admission or at 6 hours, were predictive of neurological deterioration within the initial 3 weeks of ischemic stroke, particularly for cardioembolic stroke patients.

Optimal blood pressure (BP) targets before endovascular treatment (EVT) for acute ischemic stroke are unknown. We aimed to assess the relation between admission BP and clinical outcomes and successful reperfusion after EVT. We used data from the MR CLEAN (Multicenter Randomized Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry, an observational, prospective, nationwide cohort study of patients with ischemic stroke treated with EVT in routine clinical practice in the Netherlands. Baseline systolic BP (SBP) and diastolic BP (DBP) were recorded on admission. The primary outcome was the score on the modified Rankin Scale at 90 days. Secondary outcomes included successful reperfusion (extended Thrombolysis in Cerebral Infarction score 2B-3), symptomatic intracranial hemorrhage, and 90-day mortality. Multivariable logistic and linear regression were used to assess the associations of SBP and DBP with outcomes. The relations between BPs and outcomes were tested for nonlinearity. Parameter estimates were calculated per 10 mm Hg increase or decrease in BP. We included 3180 patients treated with EVT between March 2014 and November 2017. The relations between admission SBP and DBP with 90-day modified Rankin Scale scores and mortality were J-shaped, with inflection points around 150 and 81 mm Hg, respectively. An increase in SBP above 150 mm Hg was associated with poor functional outcome (adjusted common odds ratio, 1.09 [95% CI, 1.04-1.15]) and mortality at 90 days (adjusted odds ratio, 1.09 [95% CI, 1.03-1.16]). Following linear relationships, higher SBP was associated with a lower probability of successful reperfusion (adjusted odds ratio, 0.97 [95% CI, 0.94-0.99]) and with the occurrence of symptomatic intracranial hemorrhage (adjusted odds ratio, 1.06 [95% CI, 0.99-1.13]). Results for DBP were largely similar. In patients with acute ischemic stroke treated with EVT, higher admission BP is associated with lower probability of successful reperfusion and with poor clinical outcomes. Further research is needed to investigate whether these patients benefit from BP reduction before EVT.