Change in blood pressure variability in patients with acute ischemic stroke and its effect on early neurologic outcome.

Jihoon Kang,Hee-Joon Bae,Jeong-Ho Hong,Nack Cheon Choi,Moon-Ku Han,Min Uk Jang,Ji Sung Lee,Beom Joon Kim,Tatsuo Shimosawa

doi:10.1371/journal.pone.0189216

Abstract

BackgroundHow short-term blood pressure variability (BPV) is affected in the acute stage of ischemic stroke and whether BPV is associated with early neurologic outcomes remains unclear.MethodsPatients who admitted for ischemic stroke within 24 h of symptom onset were consecutively identified between January 2010 and January 2015. BP profiles measured in real-time were summarized into short-term, 24-h time intervals, based on standard deviation (SD) and mean of systolic BP (SBPSD) during the first 3 days. The primary outcome was daily assessment of early neurological deterioration (END). The associations between short-term SBPSD values and the secular trend for primary outcome were examined.ResultsA total of 2,545 subjects (mean age, 67.1 ± 13.5 years old and median baseline National Institutes of Health Stroke Scale score, 3) arrived at the hospital an average of 6.1 ± 6.6 h after symptom onset. SBPSD values at day 1 (SD#D1), SD#D2, and SD#D3 were 14.4 ± 5.0, 12.5 ± 4.5, and 12.2 ± 4.6 mmHg, respectively. Multivariable analyses showed that SD#D2 was independently associated with onset of END at day 2 (adjusted odds ratio, 1.08; 95% confidence interval, 1.03–1.13), and SD#D3 was independently associated with END#D3 (1.07, 1.01–1.14), with adjustments for predetermined covariates, SBPmean, and interactions with daily SBPSD.ConclusionShort-term BPV changed and stabilized from the first day of ischemic stroke. Daily high BPV may be associated with neurological deterioration independent of BPV on the previous day.

Highlights

Blood pressure (BP) generally goes through abrupt and rapid changes in the acute stage of ischemic stroke; approximately 80% of stroke patients initially have an elevated BP, which subsequently stabilizes within a few days.[1,2] This abrupt reactive response has been linked to stroke prognosis, that is, the mean value of BP has been established as an important prognostic factor for cardiovascular outcome.BP variability (BPV), another element comprising the underlying theoretical true BP, has yielded inconsistent results.[3]
Multivariable analyses showed that standard deviation (SD)#D2 was independently associated with onset of early neurological deterioration (END) at day 2, and SD#D3 was independently associated with END#D3 (1.07, 1.01–1.14), with adjustments for predetermined covariates, SBPmean, and interactions with daily SBPSD
High BPV may be associated with neurological deterioration independent of BPV on the previous day

Summary

Introduction

BP variability (BPV), another element comprising the underlying theoretical true BP, has yielded inconsistent results.[3] Some studies suggested that high BPV in the acute stage of ischemic stroke exerted an adverse influence on the progress of early neurologic status.[4,5,6,7] High BPV during the first 72 h after stroke onset is associated with occurrence of hemorrhagic transformation and growth of ischemic lesion size, which subsequently increase the risk of poor outcome. How short-term blood pressure variability (BPV) is affected in the acute stage of ischemic stroke and whether BPV is associated with early neurologic outcomes remains unclear.

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Conclusion