Inter-arm Blood Pressure Difference is Associated with Recurrent Stroke in Non-cardioembolic Stroke Patients

Yoonkyung Chang,Yong-Jae Kim,Jinkwon Kim,Tae-Jin Song

doi:10.1038/s41598-019-49294-8

Abstract

Recurrent stroke increases mortality and aggravates the disability of stroke patients. We hypothesized that increased inter-arm systolic blood pressure difference and inter-arm diastolic blood pressure difference would be related to recurrent stroke in non-cardioembolic stroke patients. A total of 1226 consecutive non-cardioembolic first-ever ischemic stroke patients, in whom bilateral brachial blood pressures were measured by an automated ankle-brachial index measuring device, were included in our study. Recurrent stroke was defined as newly developed neurologic symptoms with relevant lesions on brain CT and/or MRI after 7 days or hospital discharge. Inter-arm systolic and diastolic blood pressure differences ≥10 mmHg were noted in 9.7% (120/1226) and 5.0% (62/1226) of patients, respectively. During a median 24 months of follow-up, 105 (8.5%) patients experienced recurrent stroke. Patients who had inter-arm systolic blood pressure difference ≥10 mmHg showed increased risk of recurrent stroke (hazard ratio:1.77, 95% confidence interval: 1.04–3.00, p = 0.033). Moreover, inter-arm diastolic blood pressure difference ≥10 mmHg was also independently associated with increased risk of recurrent stroke (hazard ratio:2.92, 95% confidence interval: 1.59–5.34, p = 0.001). In conclusion, inter-arm blood pressure difference ≥10 mmHg may be associated with increased risk recurrent stroke in non-cardioembolic stroke patients.

Highlights

Systolic and diastolic blood pressures are important risk factors for occurrence and recurrence of stroke[1]
Our study showed that IASBD and/or IADBD ≥10 mmHg was associated with recurrent stroke after adjustment for stroke severity (NIHSS), cerebral atherosclerosis, brachial-ankle pulse wave velocity (baPWV), and high-grade white matter hyperintensities, which were closely related factors for stroke
Our study suggests that IASBD or IADBD, which can be measured in a clinical field, may be an independent factor for associating or predicting recurrent stroke in non-cardioembolic stroke patients

Summary

Introduction

Systolic and diastolic blood pressures are important risk factors for occurrence and recurrence of stroke[1]. The latest guideline for management of hypertension recommended to check blood pressure in both arms[2], and different result is often found when checked bilaterally. These inter-arm blood pressure differences (IABDs) are reported in general population (4%), diabetic patients (7%) and stroke patients (10%)[3,4]. Stroke is one of the leading causes of disability, loss of productivity, and poor functional outcome including mortality[5,6]. In stroke patients, considering the relationship between extensive atherosclerosis and poor clinical outcome[10], IABD may have an association with recurrent stroke. Our hypothesis is that increased IABD would be related with recurrent stroke in non-cardioembolic stroke patients

Methods

Results

Conclusion