Higher Blood Pressure Variability Research Articles

Rapid Assessment of Blood Pressure Variability and Outcome After Successful Thrombectomy.

High blood pressure (BP) variability after endovascular stroke therapy is associated with poor outcome. Conventional BP variability measures require long recordings, limiting their utility as a risk assessment tool to guide clinical decision-making. Here, we performed rapid assessment of BP variability by spectral analysis and evaluated its association with early clinical improvement and long-term functional outcomes. We conducted a prospective study of 146 patients with anterior circulation ischemic stroke who underwent successful endovascular stroke therapy. Spectral analysis of 5-minute recordings of beat-to-beat BP was used to quantify BP variability. Outcomes included initial clinical response and modified Rankin Scale at 90 days. Increased BP variability at high frequencies was independently associated with poor functional outcome at 90 days (adjusted odds ratio [aOR], 1.85 [95% CI, 1.07-3.25], P=0.03; low-/high-frequency ratio aOR, 0.67 [95% CI, 0.46-0.92], P=0.02) and reduced likelihood of an early neurological recovery (aOR, 0.62 [95% CI, 0.44-0.91], P=0.01 and aOR, 1.37 [95% CI, 1.03-1.87], P=0.04, respectively). High-frequency BP oscillations after successful reperfusion may be harmful and associate with a decreased likelihood of neurological recovery and favorable functional outcomes. Rapid assessment of BP variability throughout the postreperfusion period is feasible and may allow for a more personalized BP management.

Long-Term Incidence of Stroke and Dementia in ASCOT.

Management of stroke risk factors might reduce later dementia. In ASCOT (Anglo-Scandinavian Outcome Trial), we determined whether dementia or stroke were associated with different blood pressure (BP)–lowering regimens; atorvastatin or placebo; and mean BP, BP variability, and mean cholesterol levels. Participants with hypertension and ≥3 cardiovascular disease risk factors were randomly allocated to amlodipine- or atenolol-based BP-lowering regimen targeting BP <140/90 mm Hg for 5.5 years. Participants with total cholesterol ≤6.5 mmol/L were also randomly allocated to atorvastatin 10 mg or placebo for 3.3 years. Mean and LDL (low-density lipoprotein) cholesterol, BP, and SD of BP were calculated from 6 months to end of trial. UK participants were linked to electronic health records to ascertain deaths and hospitalization in general and mental health hospitals. Dementia and stroke were ascertained by validated code lists and within-trial ascertainment. Of 8580 UK participants, 7300 were followed up to 21 years from randomization. Atorvastatin for 3.3 years had no measurable effect on stroke (264 versus 272; adjusted hazard ratio [HR], 0.92 [95% CI, 0.78–1.09]; P=0.341) or dementia (238 versus 227; adjusted HR, 0.98 [95% CI, 0.82–1.18]; P=0.837) compared with placebo. Mean total cholesterol was not associated with later stroke or dementia. An amlodipine-based compared with an atenolol-based regimen for 5.5 years reduced stroke (443 versus 522; adjusted HR, 0.82 [95% CI, 0.72–0.93]; P=0.003) but not dementia (450 versus 465; adjusted HR, 0.94 [95% CI, 0.82–1.07]; P=0.334) over follow-up. BP variability (SD mean BP) was associated with a higher risk of dementia (per 5 mm Hg HR, 1.14 [95% CI, 1.06–1.24]; P<0.001) and stroke (HR, 1.21 [95% CI, 1.12–1.32]; P<0.001) adjusted for mean BP. An amlodipine-based BP regimen reduced the long-term incidence of stroke compared with an atenolol-based regimen but had no measurable effect on dementia. Atorvastatin had no effect on either stroke or dementia. Higher BP variability was associated with a higher incidence of later dementia and stroke.

Visit-to-visit blood pressure variability in patients after acute coronary syndrome

Objective. The aim of the study was to assess the possible association of visit-to-visit blood pressure (BP) variability and the risk of adverse outcomes in hypertensive (HTN) patients after acute coronary syndrome.Design and methods. We analyzed data of 1,456 patients (mean age 65,6 ± 12,2 years, 875 (60,1 %) men) discharged from the hospital after acute coronary syndrome and followed up for 1 year in 4 vascular centers in Moscow, Astrakhan, Kazan and Krasnodar in 2014–2017. BP, heart rate, and adverse events were recorded on the day of discharge and on days 25, 90, 180 and 360 after discharge. The visit-to-visit BP variability was assessed by the VIM coefficient (variation independent of mean).Results. The systolic BP variability was 7,81 ± 0,226 mm Hg, diastolic BP variability was 9,89 ± 0,577 mm Hg during follow-up. In total, 110 deaths from any cause, 63 coronary deaths, 130 repeated non-fatal coronary events, 33 ischemic strokes were recorded. A decrease in BP variability was associated with the dihydropyridine calcium antagonists (10,21 ± 6,45 and 7,99 ± 4,70 mm Hg, p = 0,024) and thiazide diuretics (10,34 ± 6,59 and 7,63 ± 9,63 mm Hg, p = 0,049). Multivariate analysis showed that high long-term variability of BP is a more significant factor associated with the overall mortality rate than the initial severity of HTN and even the fact of achieving target BP. The risk of ischemic stroke in patients with HTN was associated with factors such as atrial fibrillation, heart failure, a history of stroke, and high visit-to-visit BP variability.Conclusions. Visit-to-visit BP variability is an important characteristic of BP control and is associated with the risk of death from any causes and stroke in patients with coronary heart disease.

Systolic blood pressure variability following endovascular thrombectomy and clinical outcome in acute ischemic stroke: A meta-analysis.

Blood pressure variability (BPV) has been linked with the outcome of acute ischemic stroke (AIS) after endovascular thrombectomy (EVT). However, the association of the stroke outcome with specific short-term BPV parameters is unclear. We did a systematic literature search for studies published from January 2010 to September 2020. Eligibility criteria included studies with (1) AIS patients treated with EVT with or without thrombolysis; and (2) analysis of the association between short-term systolic BPV parameter and clinical outcomes. Systolic BPV parameters included standard deviation (SD), coefficient of Variation (CoV), successive Variation (SV), and Variation independent of mean. A total of 11studies were meta-analyzed, comprising 3520 patients who underwent EVT. Lower odds of achieving good functional outcome at 3months; that is, modified Rankin Scale (mRS) score ≤2 was associated with SD (OR, 0.854; p=.02), CoV (OR, 0.572; p=.04), SV (OR 0.41; p=.00) of systolic blood pressure (SBP). Likewise, higher odds of one-point increase in mRS score was associated with SD (OR 1.42; p=.03), CoV (OR 1.464; p=.00) and SV (OR 2.605; p=.00) of SBP. However, high BPV was not associated with symptomatic intracranial hemorrhage and all-cause mortality at 90days. The association of BPV and early neurological deterioration was inconclusive. Based on the available studies, short-term systolic BPV is indicative of the clinical outcome of patients following EVT in AIS. Further research should focus on personalized blood pressure management strategies, rather than a one-size-fits-all approach.

Predictive value of within-visit and visit-to-visit blood pressure variability for all-cause mortality: the Minhang Study

Blood pressure variability is a common physiological phenomenon; however, the association between within-visit and visit-to-visit variability in blood pressure and all-cause mortality remains uncertain. We conducted a retrospective analysis of blood pressure variability among 11 721 adults who underwent blood pressure measurement on three occasions within a period of 6 months. Within-visit and visit-to-visit variability was quantified using the standard deviation and maximum--minimum difference between measures. The predictive effect of this variability on all-cause mortality was evaluated using Kaplan--Meier survival curves and Cox regression analysis. The incidence of all-cause mortality was significantly higher for participants in the top quintile of within-visit and visit-to-visit blood pressure variability and for those with sustained high within-visit variability. Within-visit variability was not retained as a risk factor after adjustment in Cox regression models. The hazard ratio for mortality increased from 48 to 55% for the top quintile of visit-to-visit blood pressure variability and from 56 to 61% for sustained high within-visit variability. The risk of mortality remained statistically higher even if visit-to-visit blood pressure variability was added to the model, including consistency of within-visit blood pressure variability and vice versa. Visit-to-visit and sustained high within-visit blood pressure variability were significant positive prognostic factors for all-cause mortality. Our findings underlined the clinical significance of achieving stable blood pressure in an effective plan of hypertension management.

Impact of in-hospital blood pressure variability on clinical outcomes in patients with symptomatic peripheral arterial disease.

Various types of blood pressure (BP) variability have been recognized as risk factors for future cardiovascular events. However, the prognostic impact of in-hospital BP variability in patients with symptomatic peripheral arterial disease (PAD) has not yet been thoroughly investigated. A total of 386 patients with PAD who underwent endovascular therapy in two hospitals were retrospectively included. BP variability was assessed by the coefficient of variation (CV) of systolic BP measured during hospitalization by trained nurses. The primary endpoint was a composite of major adverse cardiovascular events (cardiovascular death, acute coronary syndrome, stroke, and hospitalization for heart failure) and major adverse limb events (major amputation, acute limb ischemia, and surgical limb revascularization). The mean systolic BP and the CV of systolic BP during hospitalization were 130.8 ± 15.7 mmHg and 11.2 ± 4.1%, respectively. During the median follow-up period of 22 months, 80 patients (21%) reached the primary endpoint. Receiver operating characteristic curve analysis showed that the CV of systolic BP significantly predicted major adverse cardiovascular and limb events (area under the curve 0.60, best cutoff value 9.8, P = 0.01). Using the best cutoff value, patients with high BP variability (n = 242) had a higher risk of clinical events than those with low BP variability (n = 144) (26% vs. 12%, P < 0.001). Multivariable analysis indicated that the CV of systolic BP, age, hemodialysis, and atrial fibrillation were associated with the primary endpoint. In conclusion, greater in-hospital systolic BP variability was associated with major adverse cardiovascular and limb events in patients with symptomatic PAD undergoing endovascular therapy.

Visit-to-visit blood pressure variability is common in primary care patients: Retrospective cohort study of 221,803 adults.

Although high visit-to-visit blood pressure variability (BPV) is an independent risk factor for cardiovascular events, the frequency of high BPV is unknown. We conducted this study to define the frequency of high BPV in primary care patients, clinical correlates, and association with antihypertensive therapies. Retrospective cohort study using electronic medical record data (with previously validated case definitions based on billing codes, free text analysis of progress notes, and prescribing data) from the Canadian Primary Care Sentinel Surveillance Network of 221,803 adults with multiple clinic visits over a 2-year period. We a priori defined a standard deviation>13.0 mm Hg in visit-to-visit systolic blood pressure (SBP) as "high BPV" based on prior literature. Overall, 85,455 (38.5%) patients had hypertension (mean 6.56 visits with SBP measurement, mean SBP 134.4 with Standard Deviation [SD] 11.3, 33.2% exhibited high BPV) and 136,348 did not (mean 3.96 visits with SBP measurement, mean SBP 120.9 with SD 8.2, 16.5% had high BPV). BPV increased with age regardless of whether individuals had hypertension or not; at all ages BPV varied across antihypertensive treatment regimens and was greater in those receiving renin angiotensin blockers or beta-blockers (p<0.001). High BPV was more frequent in patients with diabetes, chronic kidney disease, dementia, depression, chronic obstructive pulmonary disease, or Parkinson's disease. High visit-to-visit BPV is present in one sixth of non-hypertensive adults and one third of hypertensive individuals and is more common in those with comorbidities. The frequency of high BPV varies across antihypertensive treatment regimens.

PROGNOSTIC IMPORTANCE OF LOW VISIT-TO-VISIT SYSTOLIC BLOOD PRESSURE VARIABILITY IN HIGH-RISK HYPERTENSION

Objective: Besides high blood pressure variability (BPV), low BPV was associated with adverse cardiovascular (CV) prognosis in selected high-risk patients. We explored this issue among high-risk, nondiabetic, nonstroke hypertensive adults from the Systolic Blood Pressure Intervention Trial (SPRINT). Design and method: Long-term SBPV (coefficient of variation, CoV %) was calculated on quarterly visits from randomization until an outcome, excluding titration period and patients with missing visits. The primary outcome was any fatal/nonfatal CV event (myocardial infarction [MI]; acute coronary syndrome not resulting in MI; stroke, acute decompensated heart failure [HF], death from CV diseases [CVD]); secondary outcomes were all-cause mortality and the composite of CV events and mortality. Multivariate (treatment arm, pulse pressure, age &gt; = 75 years, gender, race, CVD, chronic kidney disease [CKD], smoke, n.BP medications) Cox proportional hazard models with penalized smoothing splines were used to explore the potential nonlinear relationship between the continuum of CoV and the HR (95%CI) for outcomes. Sensitivity analysis based on 1:1 propensity score matching (PSM) was performed. Results: The association of SBPV with CV events was J-shaped (lowest risk for CoV 5–10%), while that with all-cause mortality and with the composite outcome was linear. After multivariate adjustment, only low SBPV (CoV &lt; 5%) was associated with CV events (HR 1.85, 95%CI 1.24–2.75), especially MI (HR 2.76, p &lt; 0.001). High SBPV (CoV&gt;10%) was associated with the risk of the composite outcome (HR 1.35, p = 0.037). PSM, matching 566 non-smoker, non-CVD/CKD participants having SBPV 5–10% with an equal number of patients having different SBPV, confirmed the inverse association of low SBPV with CV events (HR 3.33, p = 0.035). Conclusions: Nonlinear modeling indicates that low visit-to-visit SBPV has prognostic relevance in high-risk hypertensives from SPRINT. Unmeasured factors, like inflammatory and metabolic changes, might contribute to the observed results. We treated SBPV as a continuous variable calculated on 16 visits and included 60% of the SPRINT cohort, which might explain the limited analogy with earlier findings. Dedicated trials are needed to test these results and related implications.

LEFT VENTRICULAR GLOBAL FUNCTION INDEX AND BLOOD PRESSURE PARAMETERS IN UNTREATED PATIENTS WITH HYPERTENSION

Objective: The left ventricular global function index (LVGFI) is a novel marker that incorporates LV structure in the assessment of LV cardiac performance.Typically, LVGFI is assessed with MRI, but recently proposed a technique for calculating this index by echocardiography. It was previously shown that a decrease in LVGFI may be a predictor of adverse outcomes in young patients with hypertension and a preserved ejection fraction. The study aimed to elucidate the association between LVGFI and the features of the daily profile of blood pressure in untreated patients with essential hypertension (EH). Design and method: We included in the study 104 patients with EH (51 men (49%) and 53 women (51%)). Mean age 58,7 ± 11,73 years. All patients had no history of blood pressure-lowering treatment. All patients underwent echocardiography and ambulatory blood pressure monitoring (ABPM). LVGFI (%) was defined as left ventricular (LV) stroke volume/LV global volume∗100% where LV global volume was calculated as the sum of the LV mean cavity volume ((LV end-diastolic volume + end-systolic volume)/2) and myocardium volume (LV mass/density). End-diastolic and end-systolic volume were obtained using Teichholz method. Results: The mean LVGFI was 30,21 ± 7,32%. We performed a correlation analysis of the main clinical characteristics and parameters of ABPM with LVGFI. We found slight correlation between age (r = -0,215, p = 0,028) and body mass index (r = -0,378, p &lt; 0,0001) with the LVGFI. There were no significant associations between office blood pressure and echocardiography parameters. Also mean daily, daytime and night systolic and diastolic blood pressure were not correlated with LVGFI. The most significant associations were found between ABPM systolic (r = -0,307, p = 0,002) and diastolic (r = -0,355, p &lt; 0,0001) blood pressure variability. Patients with the impaired circadian rhythm of blood pressure by type of over-dipper had the lowest LVGFI (26,84 ± 3,301%) compared with patients with normal circadian rhythm (32,43 ± 6,908%) and non-dipper patients (30,49 ± 7,773%), p = 0,041. Conclusions: Lowering of LVGFI is associated with high blood pressure variability and over-dipper circadian rhythm of blood pressure.

COMPARISON OF BLOOD PRESSURE VARIABILITY BETWEEN 24H AMBULATORY MONITORING AND OFFICE BLOOD PRESSURE IN DIABETICS AND NON-DIABETIC PATIENTS A CROSS-SECTIONAL STUDY

Objective: To examine the relationship of different measurements of Blood Pressure Variability (BPV) both based on 24 h Ambulatory BP Monitoring (ABPM) and on visit-to-visit in office BP (OBP) evaluation in a large set of diabetic (D) and non-diabetic (ND) patients. Design and method: A total of 1123 patients with ABPM and OBP measurements were included in a single-center cross-sectional study: 272 (24%) D, 43% male, 41% dyslipidemia, ageing 52 years (range 38- 64), BMI 27.9 kg/m2 (range 24.7–31.3). Comparison of BPV between D and ND used Mann-Whitney U test and a generalized linear model (GLM) including D as only predictor and age &lt;65 years, BMI, gender, dyslipidemia, family history of D, of hypertension, urinary sodium and eGFR as covariates. Results: Mean systolic BP (SBP) was significantly higher in D vs ND (p &lt; 0.001), for all 24 h, daytime and nighttime periods of ABPM and for OBP. BPV in daytime ABPM was higher in D vs ND, in unadjusted analysis: coefficient of variation of SBP (CVS) for D: 9.5 (range 8.0–10.9 vs ND: 8.8 (range 7.4–10.7), p &lt; 0.001 but no measure of OBPV showed significant differences between groups. OBPV did not correlate with 24-h BP variability. Morning rise of SBP was higher in ND group (10.9 ± 0.3 vs 9.7 ± 0.6 mm Hg (p = 0.014). GLM analysis confirmed higher ambulatory SBP variability in D vs ND. CVS (24H and daytime BP p &lt; 0.001) was higher in D (vs ND) independently of other covariates. Arterial stiffness index (ASI) was higher (p &lt; 0.001) in D = 0.44 (0.35 -0.56) vs ND = 0.32 (0.20 -0.44) but weakly related with BP variability. Conclusions: BP variability on ABPM was higher in diabetic vs ND. BP variability in long-term visit-to-visit in OBP was weakly correlated to short-term ABPM variability. In diabetics the lower morning rise of BP and the higher BPV in ABPM values may indicate different spectra of adjusted vs inadequate autonomic response in D. ABPM BPV may be a relevant component of pathophysiologic path involved in higher incidence of adverse events in diabetic population.

THE ASSOCIATION OF BLOOD PRESSURE VARIABILITY WITH DEMENTIA AND COGNITIVE IMPAIRMENT: A SYSTEMATIC REVIEW AND META-ANALYSIS

Objective: A body of empirical work demonstrates that high within-individual blood pressure variability (BPV) holds prognostic value to predict stroke and transient ischemic attack. The magnitude of association between BPV and other neurological outcomes remains less clear. We aimed to summarise the current evidence on whether BPV is associated to dementia and cognitive impairment in healthy older adults. Design and method: Electronic databases were searched for full text articles and conference abstracts in English. Prospective and cross-sectional cohort studies or clinical trials in adults without cognitive impairment at baseline were eligible. Measures of BPV included any metric over any duration (i.e. visit-to-visit BPV, day-to-day BPV, 24-hour BPV), but not day-night patterns. Outcomes included: 1. incident dementia, 2. cognitive impairment (change in cognition over time), 3. the combined endpoint of dementia and cognitive impairment, and 4. cognitive function (cross-sectional studies). If the association of mean BP with the study outcome was reported, this was extracted as well, to compare to prognostic ability of BPV with mean BP. Results: After screening of the initial search of 2214 references, 40 papers were included. Seven studies assessed incident dementia, 12 assessed cognitive impairment and 23 assessed cognitive function. The majority of studies assessed visit-to-visit BPV (n = 23), followed by 24-hour BPV (n = 14) and day-to-day BPV (n = 3). Increased systolic BPV was associated with the combined endpoint of dementia and cognitive impairment (odds ratio [OR] 1.24, 95% confidence interval [CI] 1.14–1.35), however mean systolic BP was not (OR = 1.13, 95% CI 0.87 to 1.45). There was no evidence of heterogeneity between BPV and mean systolic BP effect sizes (p = 0.47 for comparison, I2 = 0%). Results for diastolic BP(V) were similar. Meta-analysis for all outcomes will be available in May 2020 at the conference. Conclusions: On the basis of the available studies, high fluctuations in systolic BP were associated with cognitive impairment. However, there was large methodological and statistical heterogeneity among studies. To clarify whether BPV is an independent risk factor for dementia and cognitive impairment, future work should involve an individual participant data meta-analysis to overcome heterogeneity in analytical approaches.

DAY-TO-DAY HOME BLOOD PRESSURE VARIABILITY IS ASSOCIATED WITH CEREBRAL SMALL VESSEL DISEASE BURDEN IN A MEMORY CLINIC POPULATION

Objective: High visit-to-visit blood pressure variability (BPV) has been associated with cognitive decline and cerebral small vessel disease (cSVD), in particular with cerebrovascular lesions. It is likely that the causes and consequences of high BPV depend on which temporal resolution is investigated. Day-to-day BPV has been related to cognitive function, but has not been investigated in relation to cSVD. Therefore, we aimed to investigate the cross-sectional association between day-to-day BPV and total cSVD MRI burden, in older memory clinic patients. Design and method: We included outpatients referred to our memory clinic, who underwent cerebral MRI as part of their diagnostic assessment. Four markers of cSVD were visually rated, resulting in a score between 0 and 4: presence of microbleed(s), presence of lacune(s), severe white matter hyperintensities and enlarged perivascular spaces in the basal ganglia. Home blood pressure (BP) measurements were performed for one week according to international guidelines. After removal of day 1, BPV was defined as the coefficient of variation (CV). We used multivariable ordinal logistic regression analyses adjusted for age, sex, smoking, diabetes, history of cardiovascular disease and mean BP to assess the association between total cSVD score and BPV. Results: In 82 patients (aged 71.2 ± 7.9 years), mean home BP was 140/79 ± 15/9 mmHg. Dementia and mild cognitive impairment were present in 46% and 34%, respectively. 22% of the study population had a total cSVD score of 0. These frequencies 24%, 26%, 20% and 8% for scores of 1, 2, 3 and 4, respectively. Systolic CV was associated with total cSVD burden, with the adjusted odds ratio per point increase in CV = 1.30, 95% confidence interval = 1.05–1.61, p = 0.018. There were no differences in diastolic CV and mean BP between the cSVD groups. When we differentiated between morning and evening BP, only evening BPV remained significantly associated with total cSVD burden. Conclusions: Day-to-day systolic BPV is associated with cSVD burden in memory clinic patients. Future research should indicate whether lowering day-to-day systolic BPV should be included in BP management in older people with memory complaints.

Low intracranial pressure variability is associated with delayed cerebral ischemia and unfavorable outcome in aneurysmal subarachnoid hemorrhage

PurposeHigh intracranial pressure variability (ICPV) is associated with favorable outcome in traumatic brain injury, by mechanisms likely involving better cerebral blood flow regulation. However, less is known about ICPV in aneurysmal subarachnoid hemorrhage (aSAH). In this study, we investigated the explanatory variables for ICPV in aSAH and its association with delayed cerebral ischemia (DCI) and clinical outcome.MethodsIn this retrospective study, 242 aSAH patients, treated at the neurointensive care, Uppsala, Sweden, 2008–2018, with ICP monitoring the first ten days post-ictus were included. ICPV was evaluated on three time scales: (1) ICPV-1 m—ICP slow wave amplitude of wavelengths between 55 and 15 s, (2) ICPV-30 m—the deviation from the mean ICP averaged over 30 min, and (3) ICPV-4 h—the deviation from the mean ICP averaged over 4 h. The ICPV measures were analyzed in the early phase (day 1–3), in the early vasospasm phase (day 4–6.5), and the late vasospasm phase (day 6.5–10).ResultsHigh ICPV was associated with younger age, reduced intracranial pressure/volume reserve (high RAP), and high blood pressure variability in multiple linear regression analyses for all ICPV measures. DCI was associated with reduced ICPV in both vasospasm phases. High ICPV-1 m in the post-ictal early phase and the early vasospasm phase predicted favorable outcome in multiple logistic regressions, whereas ICPV-30 m and ICPV-4 h in the late vasospasm phase had a similar association.ConclusionsHigher ICPV may reflect more optimal cerebral vessel activity, as reduced values are associated with an increased risk of DCI and unfavorable outcome after aSAH.

Blood pressure, blood pressure variability and the risk of poststroke dementia.

High blood pressure and blood pressure variability are potential, modifiable risk factors of poststroke dementia. We aimed to investigate the association between achieved blood pressure, blood pressure variability and poststroke dementia. We studied 17 064 patients with noncardioembolic ischemic stroke included in the Prevention Regimen for Effectively avoiding Second Strokes (PRoFESS) trial. We analysed the data as a single observational cohort. We studied mean achieved SBP and DBP and blood pressure variability defined as coefficient of variation (SD/mean∗100). The association between blood pressure and dementia was investigated with logistic regression analysis, correcting for sociodemographic factors and cardiovascular risk factors. During 39 818 person-years of follow-up, 817 patients were diagnosed with dementia (2.1 per 100 person-years). We found a significant nonlinear association between mean SBP and the risk of dementia, implying a U-shaped association between mean SBP and dementia. Mean SBP of 120-129 mmHg was associated with a significantly higher risk of dementia than 130-139 mmHg [odds ratio (OR) 1.28; 95% confidence interval (95% CI) 1.03-1.58]. There was no indication of a U-shaped association between mean DBP and dementia, and no significant association between mean DBP categories and dementia. Higher blood pressure variability was associated with an increased risk of dementia (OR 1.06 per point increase, 95% CI 1.02-1.04), independent of mean SBP. Among patients with a recent noncardioembolic ischemic stroke, there appears to be a U-shaped association between achieved SBP and dementia. High blood pressure variability is associated with an increased risk of poststroke dementia.

Blood pressure variability is related to faster cognitive decline in ischemic stroke patients: PICASSO subanalysis

Blood pressure variability (BPV) is associated with higher cardiovascular morbidity risks; however, its association with cognitive decline remains unclear. We investigated whether higher BPV is associated with faster declines in cognitive function in ischemic stroke (IS) patients. Cognitive function was evaluated between April 2010 and August 2015 using the Mini-mental State Examination (MMSE) and Montreal Cognitive Assessment in 1,240 Korean PICASSO participants. Patients for whom baseline and follow-up cognitive test results and at least five valid BP readings were available were included. A restricted maximum likelihood–based Mixed Model for Repeated Measures was used to compare changes in cognitive function over time. Among a total of 746 participants (64.6 ± 10.8 years; 35.9% female). Baseline mean-MMSE score was 24.9 ± 4.7. The median number of BP readings was 11. During a mean follow-up of 2.6 years, mean baseline and last follow-up MMSE scores were 25.4 ± 4.8 vs. 27.8 ± 4.4 (the lowest BPV group) and 23.9 ± 5.2 vs. 23.2 ± 5.9 (the highest BPV group). After adjusting for multiple variables, higher BPV was independently associated with faster cognitive decline over time. However, no significant intergroup difference in cognitive changes associated with mean systolic BP was observed. Further research is needed to elucidate how BPV might affect cognitive function.

Abstract MP33: Association Between Neurologic Outcomes and Temporal Profile of Systolic Blood Pressure Variability After Endovascular Thrombectomy

Introduction: Higher systolic blood pressure variability (BPV) after endovascular thrombectomy (EVT) has been associated with an increased risk of hemorrhagic transformation and worse functional outcomes. However, the time-varying behavior of BPV after EVT and its effects on functional outcome have not been well characterized. Methods: We analyzed data from an international cohort of patients with acute large-vessel occlusion stroke who underwent EVT at 11 centers across North America, Europe, and Asia. Repeated time-stamped blood pressure data were recorded for the first 72 hours after thrombectomy. Parameters of BPV were calculated in 12-hour epochs using five established methodologies: standard deviation (SD), coefficient of variation (CV), average real variability (ARV), successive variation (SV), and residual SD (rSD). Patients’ overall mean BPV was then used to assign patients into tertiles for regression analysis: low BPV, intermediate BPV, and high BPV. Functional outcome was measured with the modified Rankin Scale (mRS) at 90 days. Results: Of the 1,791 patients (age 69 ± 14, NIHSS 15 ± 6) included in our analysis, 1,085 (60.6%) had a poor 90-day outcome (mRS &gt;3). Patients with poor outcome had significantly higher systolic BPV (p&lt;0.05) measured as standard deviation (SBP SD) at each epoch (Figure 1B). Compared to patients with low BPV, those in the highest tertile group had significantly greater odds of a poor functional outcome after adjusting for age, sex, hypertension, NIHSS, ASPECT, tPA, time to reperfusion, and TICI score (OR 1.5; 95% CI 1.2-2; p=0.001). Patients in the highest tertile of BPV demonstrated time-dependent variability with the highest SBP SD during the first 24 hours after thrombectomy (Figure 1A). Conclusions: Higher BPV measured by SBP SD appears to be associated with poor 90-day outcome in EVT-treated stroke patients. Early treatment strategies targeting early high BPV warrant further prospective investigation.

Association of Blood Pressure Variability and Diuretics With Cardiovascular Events in Patients With Chronic Kidney Disease Stages 1-5.

Visit-to-visit blood pressure variability (BPV) is associated with cardiovascular events in the general population. Data are scarce in chronic kidney disease. We hypothesized that BPV would be associated with cardiovascular outcomes, death, and end-stage kidney disease (ESKD) and that diuretics would modify these associations in patients with chronic kidney disease. We studied US Veterans with nondialysis chronic kidney disease stages 1-5 and hypertension on nondiuretic antihypertensive monotherapy. At the time of second antihypertensive agent prescription, we propensity-matched for exposure to a loop or thiazide diuretic versus any other antihypertensive. BPV was defined as the coefficient of variation of systolic blood pressure over 6 months after second agent prescription. Cox proportional hazards regression measured associations of BPV with a primary cardiovascular event composite (fatal or nonfatal myocardial infarction or ischemic stroke; heart failure hospitalization). Secondary outcomes included all-cause death, each primary outcome component, end-stage kidney disease, and cardiovascular death. There were 31 394 participants in each group. BPV was associated with composite cardiovascular events, hazard ratio (95% CI) at second, third, fourth, and fifth versus first quintile: 1.79 (1.53-2.11), 2.32 (1.99-2.71), 2.60 (2.24-3.02), and 3.12 (2.68-3.62). Diuretics attenuated associations between the fourth and fifth BPV quintiles with composite events (Pinteraction=0.03 and 0.04, respectively). BPV was associated with all secondary outcomes except end-stage kidney disease, with no diuretic interactions. BPV was associated with cardiovascular events and death but not end-stage kidney disease in patients with chronic kidney disease, with attenuated associations with cardiovascular events in the diuretic-treated group at high BPV quintiles. Future studies should investigate whether other antihypertensive classes modify these risks.

Blood pressure variability and outcomes after mechanical thrombectomy based on the recanalization and collateral status.

Background:Blood pressure (BP), recanalization status, and collateral circulation are important factors for cerebral autoregulation after stroke. We aimed to investigate the association of various BP variability (BPV) parameters with clinical outcomes after mechanical thrombectomy (MT) according to recanalization and collateral status.Methods:We included 502 consecutive patients who underwent MT due to anterior circulation large vessel occlusion stroke at three comprehensive stroke centers. BPV parameters were standard deviation (SD), maximum/minimum BP, coefficient of variation (CV) and successive variation (SV). The clinical outcomes included 90-day functional outcome assessed by modified Rankin Scale score and symptomatic intracranial hemorrhage (sICH).Results:Among the included patients, 219 (43.6%) achieved good functional outcomes and 59 (11.8%) developed sICH. After adjusting for confounders, higher systolic BP (SBP) variability [CV (odds ratio (OR), 1.089, p = 0.035), SV (OR, 1.082, p = 0.004). and SD (OR, 1.074, p = 0.027)] was associated with a lower likelihood of a favorable outcome. In addition, higher SBP [CV (OR, 1.156, p = 0.001) and SD (OR, 1.118, p = 0.001)] were significantly associated with increased odds of sICH. Moreover, the relationship between BPV and the outcomes depended on recanalization status. However, regardless of collateral status, a higher BPV after MT was associated with worse outcomes.Conclusions:Higher SBP SD and CV during the first 24 h after MT was a powerful predictor of worse clinical outcomes, regardless of the collateral status. However, the effects of BPV on outcomes were more substantial among patients with successful reperfusion.

Complications of White-coat Hypertension Compared to a Normotensive and Hypertensive Population.

Background:Accumulating evidence demonstrates that white-coat hypertension (WCH) are associated with several risks and complications. In this study, we aimed to investigate the adverse effects of WCH compared with hypertensive and normotensive patients.Methods:A retrospective cohort study was conducted over five years. Blood pressure (BP) data was collected from both clinic visits and 24-h ambulatory blood pressure monitoring (ABPM) reports. Epidemiological data and complications, cardiac and noncardiac, were also recorded.Results:In total, 286 participants who were followed up for at least three years were included. The sample was divided into 99 normotensive patients (as a control group), 94 patients with clinically diagnosed hypertension (HTN), and 93 patients with WCH. Ischemic heart disease (IHD) was the most noted complication in the WCH group with a relative risk of 9.58 (1.23–74.16) (P = 0.008). Acute coronary syndrome (ACS) was significantly correlated with a relative risk of 2.06 (0.52–13.38). No significant correlation was noted with noncardiac complications. Both HTN and WCH groups showed a significant association with blood pressure variability (BPV). WCH was associated with an increased BPV in ambulatory daytime systolic measurements (P = 0.031) and a unique increase in diastolic measurement variability in office BP measurements (P = 0.020).Conclusion:WCH should be managed as HTN. WCH is associated with cardiac complications, particularly IHD, specifically in patients 55 years and older. WCH was significantly associated with a higher BPV in both ABPM and office-based measurements.

Which Parameters of Beat-to-Beat Blood Pressure Best Predict Poor In-Hospital Outcome in Spontaneous Intracerebral Hemorrhage?

Objective: There is increasing evidence that high blood pressure (BP) levels and BP variability (BPV) over 24 h or longer are associated with poor clinical outcomes in patients with intracerebral hemorrhage (ICH). The objective of this study was to examine the association between different beat-to-beat BP parameters and in-hospital outcomes.Methods: Patients with a diagnosis of acute spontaneous ICH were recruited consecutively and prospectively between September 2018 and January 2019. Beat-to-beat recordings were measured non-invasively for 5 min within the first 72 h after the onset of symptoms. BPV was analyzed by standard deviation (SD), coefficient of variation (CV), average real variability (ARV), and variation independent of mean (VIM). Outcome was assessed at discharge using the modified Rankin Scale (mRS) score. Multivariate logistic regression analysis was used to assess the association between BP levels, BPV, and clinical outcomes.Results: A total of 66 patients were included, of whom 34 had poor outcomes (mRS score, 3–6). Patients with poor outcomes had significantly higher National Institute of Health Stroke Scale scores (4.5 vs. 9, p < 0.001), a larger ICH volume (8 vs. 14.5 mL, p = 0.004), and an increased systolic BP (SBP) -CV (3.2 vs. 4.8, p < 0.001) and diastolic BP (DBP) -CV (3.7 vs. 4.9, p = 0.015). After adjustment for major covariates, multivariate logistic regression analysis revealed that SBP-CV was independently associated with an increased risk of poor in-hospital outcomes [odds ratio (OR) 2.535; 95% confidence interval (CI), 1.211–5.305; p = 0.014]. The receiver operating characteristic area for SBP-CV in predicting poor in-hospital outcome was 0.827 (95% CI, 0.730–0.925; p < 0.001), and the best cutoff point was 3.551 (sensitivity, 82.35%; specificity, 68.75%).Conclusion: A higher beat-to-beat BPV in the first 72 h of admission was associated with unfavorable in-hospital outcomes in patients with ICH. The stabilization of BPV during the acute phase may be a therapeutic target; this could be tested in future clinical trials.