Higher Systolic Blood Pressure Variability Research Articles

Blood pressure variability predicts poor outcomes in acute stroke patients without thrombolysis: a systematic review and meta-analysis.

Stroke is a significant medical condition, and blood pressure stands out as the most prevalent treatable risk factor associated with it. Researches link blood pressure variability (BPV) with stroke; however, the specific relationship between with the outcomes of stroke patients remains unclear. As blood pressure variability and mean blood pressure are interrelated, it remains uncertain whether BPV adds additional information to understanding the outcome of acute stroke patients. To systematically review studies investigating the association between blood pressure variability and prognosis in acute stroke patients. Embase, PubMed, Web of Science, and the Cochrane Library were searched for English language full-text articles from the inception to 1 January 2023. Stroke patients aged ≥ 18years were included in this analysis. Stroke types were not restricted. This meta-analysis shows that higher systolic blood pressure variability is linked to a higher risk of poor outcome, including function disability, mortality, early neurological deterioration, and stroke recurrence, among acute stroke patients without thrombolysis. A higher diastolic blood pressure variability is linked with to a higher risk of mortality and functional disability. This review reveals that blood pressure variability is a novel and clinically relevant risk factor for stroke patients' outcome. Future studies should investigate how best to measure and define BPV in acute stroke. Larger studies are warranted to provide more robust evidence in this area.

Effect of visit-to-visit blood pressure variability on mild cognitive impairment and probable dementia in hypertensive patients receiving standard and intensive blood pressure treatment.

High visit-to-visit blood pressure variability (BPV) and hypertension are risk factors for mild cognitive impairment (MCI) and probable dementia (PD). Few articles assessed the effect of BPV on the MCI and PD in intensive blood pressure treatment and the different functions of three types of visit-to-visit BPV: systolic blood pressure variability (SBPV), diastolic blood pressure variability (DBPV) and pulse pressure variability (PPV). We performed a post hoc analysis of the SPRINT MIND trial. The primary outcomes were MCI and PD. BPV was measured by average real variability (ARV). The Kaplan-Meier curves were used to clarify the difference in tertiles of BPV. We fit Cox proportional hazards models to our outcome. We also did an interaction analysis between the intensive and standard groups. We enrolled 8,346 patients in the SPRINT MIND trial. The incidence of MCI and PD in the intensive group was lower than that in the standard group. 353 patients had MCI and 101 patients had PD in the standard group while 285 patients had MCI and 75 patients had PD in the intensive group. Tertiles with higher SBPV, DBPV and PPV in the standard group had a higher risk of MCI and PD (all p < 0.05). Meanwhile, higher SBPV and PPV in the intensive group were associated with an increased risk of PD (SBPV: HR(95%) = 2.1 (1.1-3.9), p = 0.026; PPV: HR(95%) = 2.0 (1.1-3.8), p = 0.025 in model 3) and higher SBPV in the intensive group was associated with an increased risk of MCI(HR(95%) = 1.4 (1.2-1.8), p < 0.001 in model 3). The difference between intensive and standard blood pressure treatment was not statistically significant when we considered the effect of the higher BPV on the risk of MCI and PD (all p for interaction >0.05). In this post hoc analysis of the SPRINT MIND trial, we found that higher SBPV and PPV were associated with an increased risk of PD in the intensive group, and higher SBPV was associated with an increased risk of MCI in the intensive group. The effect of higher BPV on the risk of MCI and PD was not significantly different in intensive and standard blood pressure treatment. These findings emphasized the need for clinical work to monitor BPV in intensive blood pressure treatment.

Abstract P392: Association Between Blood Pressure Variability and Subclinical Measures of Cardiovascular Disease in Desk Workers

Introduction: Previous research has demonstrated that variability in resting blood pressure (BP) across arms, measurements, or days may be associated with an increased risk for cardiovascular disease (CVD) and mortality. Yet, the extent to which BP variability increases cardiovascular risk and the mechanisms explaining this association are unclear. This study evaluated associations between BP variability with subclinical pathways of CVD development (arterial stiffness (pulse wave velocity [PWV]) and cardiac autonomic function (heart rate variability [HRV]) in desk workers. Hypothesis: Higher BP variability will be associated with higher PWV and lower (worse) HRV Methods: This secondary analysis of baseline data from the Effect of Reducing Sedentary on Blood Pressure randomized controlled trial included 265 sedentary and inactive desk workers (mean age 44.9±11.6 years; 82.0% white; 57.9% female) with elevated-to-stage 2 hypertension and who were not using antihypertensive medication. Sequential BP measurements determined the arm with the higher systolic BP by using an oscillometric device (Omron HEM-907XL). BP was then measured at least twice from the arm with the higher systolic BP at the first (visit-1) and second (visit-2) visits, occurring ≤30 days apart. Systolic BP variability metrics included inter-arm (first measurements between arms at visit-1), intra-arm (first two measurements on the arm with higher systolic BP at visit-1), and inter-visit (average BP from repeated measurements on the same arm across visits-1 and -2). Subclinical measures of CVD included resting carotid- femoral(cfPWV) and carotid-radial(crPWV) PWV (Complier Analyse) and the log transformed standard deviation of normal R-R intervals (SDNN) and the root mean square of the successive differences (RMSSD) HRV measures (Polar Electro). Adjusted linear regression estimated the associations between subclinical measures of CVD and BP variability metrics; Metrics were operationalized into three categories: differences of 0-5 mmHg, 6-10 mmHg, and 11 or more mmHg. Results: The prevalence of having 6 mmHg or more difference for the inter-arm, intra-arm, and inter-visit systolic BP was 43%, 38%, and 53%, respectively. PWV and HRV were not different across categories of inter-arm systolic BP variability or inter-visit systolic BP variability (all p&gt;0.05). However, a same-day intra-arm difference in systolic BP of 6-10 mmHg within visit-1 was associated with higher cfPWV (β=0.42 m/s, (95% CI: 0.07, 0.77) as compared to those with an intra-arm difference of 0-5 mmHg. Conclusion: These data suggest that higher systolic BP variability in the same arm within visit, but not variability across arms or between visits, may be associated with higher aortic stiffness in desk workers with untreated elevated-to-stage 2 hypertension.

Hipertansiyonlu İrritabl Barsak Sendromlu Hastalarda Klinik Alt Tipler Arasında Kan Basıncı Değişkenliğinin Karşılaştırılması

Objective: In this study, we aimed to compare blood pressure variability among irritable bowel syndrome subtypes. Methods: Patients with newly diagnosed irritable bowel syndrome and existing hypertension were included in the study. Average real variability (ARV) was calculated by consecutive one week home blood pressure measurements. Groups were compared for blood pressure variability. Results: While diastolic ARV was found to be similar among subtypes (p=0.919), a significant difference was found between them in terms of systolic ARV (p&amp;lt;0.001). Conclusion: Since irritable bowel syndrome patients with constipation-predominant subtype have higher systolic blood pressure variability, these patients can be followed more closely for cardiovascular complications.

Blood pressure variability, dementia, and role of antihypertensive medications in older adults.

We assessed the association between visit-to-visit blood pressure variability (BPV) up to 12 years and subsequent dementia risk, and tested the modifying effect of antihypertensive medications. We studied 2234 participants from two community-based cohorts of older adults with normal cognition or mild cognitive impairment. Participants were followed through annual assessments for up to 27 years. Visit-to-visit BPV was quantified over 3, 6, 9, and 12 years, respectively. Higher systolic BPV (SBPV) during 3, 6, 9, and 12 years was associated with a subsequent increased risk of dementia, with hazard ratios ranging from 1.02 (95% confidence interval [CI]: 1.01-1.04) to 1.10 (95% CI: 1.05-1.16). The association between SBPV and dementia risk was stronger among participants not taking calcium channel blockers (p-for interaction<0.05). Among older adults, long-term exposure to higher visit-to-visit SBPV is associated with an increased risk of dementia later in life, and calcium channel blockers may modify this association. Among adults aged>65,higher systolic blood pressure variability spanning 3-12 years is associated with an increased risk of dementia later in life. Single blood pressure measurement or mean blood pressure levels does not seem to associate with dementia risk among older adults. The association between systolic blood pressure variability and dementia risk is stronger among those not taking calcium channel blocker medications.

Perioperative systemic blood pressure parameters and clinical outcomes following 27g vitrectomy for diabetic tractional detachment repair

BackgroundExtremes in perioperative blood pressures are known risk factors for adverse outcomes after surgical interventions. There is scarce literature studying these parameters as predictors of outcomes after ocular surgery.MethodsThis was...

Short-term blood pressure variability is inversely related to regional amplitude of low frequency fluctuations in older and younger adults

Blood pressure variability (BPV), independent of mean blood pressure levels, is associated with cerebrovascular disease burden on MRI and postmortem evaluation. However, less is known about relationships with markers of cerebrovascular dysfunction, such as diminished spontaneous brain activity as measured by the amplitude of low frequency fluctuations (ALFF), especially in brain regions with vascular and neuronal vulnerability in aging. We investigated the relationship between short-term BPV and concurrent regional ALFF from resting state fMRI in a sample of community-dwelling older adults (n = 44) and healthy younger adults (n = 49). In older adults, elevated systolic BPV was associated with lower ALFF in widespread medial temporal regions and the anterior cingulate cortex. Higher systolic BPV in younger adults was also related to lower ALFF in the medial temporal lobe, albeit in fewer subregions, and the amygdala. There were no significant associations between systolic BPV and ALFF across the right/left whole brain or in the insular cortex in either group. Findings suggest a possible regional vulnerability to cerebrovascular dysfunction and short-term fluctuations in blood pressure. BPV may be an understudied risk factor for cerebrovascular changes in aging.

1013: OUTCOME FROM SPONTANEOUS INTRAPARENCHYMAL HEMORRHAGE DURING CRITICAL CARE RESUSCITATION UNIT STAY

Introduction: Patients with spontaneous intraparenchymal hemorrhage (sIPH) often have high morbidity and mortality. Previous studies found that the first 24-hour systolic blood pressure variability (SBPV) was associated with worse functional outcome in patients. However, whether SBPV in the hyperacute phase in patients with sIPH is not known. We hypothesized that sBPV during patients’ resuscitation phase at the Critical Care Resuscitation (CCRU) at the University of Maryland Medical Center would correlate with increased hematoma progression (HP) and patients’ outcome. Methods: We retrospectively analyzed charts from adult patients who were admitted to the CCRU for management of sIPH from Jan. 2016 to Jan. 2021. Forward multivariable stepwise logistic regression was performed for the primary outcome of HP. We also performed multiple linear regression with Box-Cox transformation to normalize continuous components of BPV, namely Standard Deviation and Successive Variation in SBP (SBPSD) and SBPSV, respectively. Multivariable ordinal logistic regression was also performed for hospital disposition, ranking from discharge home to Dead/hospice. Results: We preliminarily analyzed 60 patients. Eighteen (30%) patients had HP. During CCRU stay, 23 (38%) required ventilation, 39 (65%) needed at least 1 antihypertensive infusion, 23 (38%) received hyperosmolar therapy, and 17 (28%) underwent external ventricular drain placement. Twelve (12, 20%) patients were discharged to home, 30 (50%) to rehabilitation facilities, 6 (10%) to skilled nursing homes, and 12 (20%) died. Our multivariable logistic regression found no factors in CCRU associated with HP. Highest SBP during CCRU stay (SBPmax) was associated with higher SBPSD (correlation coefficient =0.03, P< 0.001) and SBPSV (corr. coef. = 0.02, P< 0.001). High ICH score was associated with hospital disposition, higher ICH score was more likely associated with patient mortality (corr. Coeff = -1.2, OR 0.3, 95% CI 0.15-0.6, P< 0.001) Conclusions: SBPmax during CCRU stay was associated with higher SBPV in patients with sIPH during the resuscitation phase at the CCRU. Additionally, only one patients’ clinical factor, ICH score, was associated with levels of their hospital disposition. Additional studies with larger sample sizes are needed.

Temporal profiles of systolic blood pressure variability and neurologic outcomes after endovascular thrombectomy.

Observational studies have found an increased risk of hemorrhagic transformation and worse functional outcomes in patients with higher systolic blood pressure variability (BPV). However, the time-varying behavior of BPV after endovascular thrombectomy (EVT) and its effects on functional outcome have not been well characterized. We analyzed data from an international cohort of patients with 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 h after thrombectomy. Parameters of BPV were calculated in 12-h epochs using five established methodologies. Systolic BPV trajectories were generated using group-based trajectory modeling, which separates heterogeneous longitudinal data into groups with similar patterns. Of the 2041 patients (age 69 ± 14, 51.4% male, NIHSS 15 ± 7, mean number of BP measurements 50 ± 28) included in our analysis, 1293 (63.4%) had a poor 90-day outcome (mRS ⩾ 3) or a poor discharge outcome (mRS ⩾ 3). We identified three distinct SBP trajectories: low (25%), moderate (64%), and high (11%). Compared to patients with low BPV, those in the highest trajectory group had a significantly greater risk of a poor functional outcome after adjusting for relevant confounders (OR 2.2; 95% CI 1.2-3.9; p = 0.008). In addition, patients with poor outcomes had significantly higher systolic BPV during the epochs that define the first 24 h after EVT (p < 0.001). Acute ischemic stroke patients demonstrate three unique systolic BPV trajectories that differ in their association with functional outcome. Further research is needed to rapidly identify individuals with high-risk BPV trajectories and to develop treatment strategies for targeting high BPV.

BLOOD PRESSURE VARIABILITY AND MIND COGNITION IMPAIRMENT: A SYSTEMIC REVIEW AND META-ANALYSIS

Objective: Blood pressure variability is hypothesized to play important role in development of cognition impairment. We aimed to explore the relationship of blood pressure variability and cognition impairment. Design and method: We searched the following databases, EMBASE, Cochrane Library, Web of Science, up to October 2021 using blood pressure variability, cognition impairment, cognition dysfunction. Randomized double blind and observational trials were included. Dementia and Alzheimer’s disease cases were excluded. Two reviewers confirmed the inclusion of studies and extracted the data independently. STATA V.15.1 was used to synthesize data. Results: We included 23 studies and enrolled 42964 hypertensive patients. All studies assessed cognition function using Mini-Mental State Examination (MMSE) or other cognition function test. Ambulatory blood pressure variability, visit-to-visit blood pressure variability, measure to measure blood pressure variability, day-to-day blood pressure variability and beat-to-beat systolic blood pressure variability were applied in included trials. The variability of systolic blood pressure has significant relationship with cognition impairment (OR,1.747[1.25,2.44], P &lt; 0.01), however, the variability of diastolic blood pressure did not show relationship with decreasing cognition function scale(OR,0.912[0.81,1.03], P&gt; 0.05) by nalysing data which trial used MMSE scale. Results showed higher systolic blood pressure variability had negative relationship with attention (OR,1.63, [1.28,1.98], P &lt; 0.01). In the aspect of memory and language function, blood pressure variability did not show a significant relationship. Higher blood pressure variability in both systolic and diastolic was associated with lower hippocampal volume and cortical infarcts. Conclusions: The variability of systolic blood pressure is dependently risk factor for cognition impairment in older adults with hypertension. For unsuccessfully treated hypertensive individuals (with blood pressured more than 140/90 mmHg),higher variability in both systolic and diastolic blood pressure was associated with cognitive damage, but these associations were not found in those controlled hypertension older adults.

Association between visit-to-visit blood pressure variability and risks of dementia in CKD patients: a nationwide observational cohort study.

The association between visit-to-visit blood pressure (BP) variability and dementia risk in chronic kidney disease (CKD) patients has rarely been studied. In this retrospective observational study, individuals who received three or more general health screenings were identified in the nationwide database of Korea. Those with persistent non-dialysis-dependent CKD [estimated glomerular filtration rate (eGFR) <60mL/min/1.73 m2 or dipstick albuminuria ≥1+] were included. The study exposure was systolic or diastolic BP variability, calculated as the variation independent of the mean and categorized into quartiles (Q4: the highest quartile; Q1: the lowest quartile). The risks of all-cause dementia, including Alzheimer's disease and vascular dementia, were analyzed by Cox regression adjusted for various clinical characteristics, including baseline BP and eGFR values. We included 103139 CKD patients and identified 7574 (7%) dementia events, including 5911 (6%) Alzheimer's disease cases, 886 (1%) vascular dementia events and 777 (1%) cases categorized as other types of dementia. Higher systolic BP variability was significantly associated with higher risks of all-cause dementia {[Q4 versus Q1], hazard ratio [HR] 1.173 [95% confidence interval (CI) 1.102-1.249], P for trend<.001}. The results were also significant for the risk of Alzheimer's disease [HR 1.162 (95% CI 1.083-1.248), P<.001] and vascular dementia [HR 1.282 (95% CI 1.064-1.545), P=.039]. The results were similar when diastolic BP variability was the exposure, as high diastolic BP variability was significantly associated with higher risks of all-cause dementia [HR 1.191 (95% CI 1.117,1.270), P<.001]. Higher visit-to-visit BP variability is significantly associated with a higher risk of dementia in CKD patients.

Association Between Blood Pressure Variability With Dementia and Cognitive Impairment: A Systematic Review and Meta-Analysis.

[Figure: see text].

Sleep moderates the association between arterial stiffness and 24-hour blood pressure variability

BackgroundArterial stiffness and increased blood pressure variability (BPV) are important subclinical cardiovascular diseases (CVDs). Evidence is accumulating that poor sleep is associated with subclinical CVDs. The purpose of our study was to investigate how sleep was related to arterial stiffness and BPV. We also explored whether sleep moderated the association between arterial stiffness and BPV. MethodsWe conducted a cross-sectional study including 78 healthy adults aged between 35 and 64 years. Variables of interest were: 1) objective seep characteristics, assessed with a wrist actigraphy for two consecutive nights; 2) arterial stiffness, measured by carotid-femoral pulse wave velocity (cfPWV); and 3) BPV, measured using an ambulatory blood pressure monitor over 24 h and estimated by average real variability. ResultsLower sleep efficiency was an independent predictor of higher cfPWV and higher systolic BPV, while longer wake after sleep onset (WASO) was an independent predictor of higher cfPWV only. In addition, cfPWV showed a positive relationship with systolic BPV, and this relationship was moderated by sleep efficiency and WASO, respectively. The relationship between cfPWV and systolic BPV became stronger among individuals who had a level of sleep efficiency lower than 84% and who had WASO higher than 67 min, respectively. ConclusionOur study showed that poor sleep not only directly linked with arterial stiffness and BPV but also moderated the relationship between these two subclinical CVDs. These findings suggest that improving sleep quality could be a target intervention to promote cardiovascular health in clinical practice.

Lower complexity and higher variability in beat-to-beat systolic blood pressure are associated with elevated long-term risk of dementia: The Rotterdam Study.

We hypothesized that subclinical disruption in blood pressure (BP) dynamics, captured by lower complexity and higher variability, may contribute to dementia risk, above and beyond BP levels. This prospective cohort study followed 1835 older adults from 1997 to 2016, with BP complexity quantified by sample entropy and BP variability quantified by coefficient of variation using beat-to-beat BP measured at baseline. Three hundred thirty-four participants developed dementia over 20 years. Reduced systolic BP (SBP) complexity was associated with a higher risk of dementia (hazard ratio [HR] comparing extreme quintiles: 1.55; 95% confidence interval [CI]: 1.09-2.20). Higher SBP variability was also associated with a higher risk of dementia (HR comparing extreme quintiles: 1.57; 95% CI: 1.11-2.22. These findings were observed after adjusting for age, sex, apolipoprotein E (APOE) genotype, mean SBP, and other confounding factors. Our findings suggest that lower complexity and higher variability of beat-to-beat SBP are potential novel risk factors or biomarkers for dementia.

Higher Systolic Blood Pressure Variability After Endovascular Thrombectomy Is Associated with Poor Functional Outcome (2903)

Higher Systolic Blood Pressure Variability After Endovascular Thrombectomy Is Associated with Poor Functional Outcome (2903)

Abstract P511: Optimal Blood Pressure Targets Following Successful Revascularization With Mechanical Thrombectomy

Background/Objective: Blood pressure parameters for patients undergoing mechanical thrombectomy (MT) are not clearly defined. Prior studies have shown that higher maximum and mean systolic blood pressure (SBP) is associated with adverse outcomes. Our study sought to investigate the relationship of blood pressure on clinical outcomes after successful revascularization and determine optimal thresholds for BP parameters that correlated with a poor functional outcome. Methods: This was a retrospective observational study of 88 consecutive patients who received successful MT at one comprehensive stroke center. Systolic, diastolic, and mean arterial pressure values were recorded for each patient over a 48-hour period, as well as patient age and National Institutes of Health Stroke Scale (NIHSS). Outcome measures included modified Rankin Score (mRS), intracranial hemorrhage (ICH), and mortality at time of discharge and 90 days. Both univariable and multivariable logistic regression analysis was performed to identify associations between the BP covariates and functional outcomes. Results: A higher SBP standard deviation (SD) of &gt;14mmHg (OR=1.150) and wider SBP range &gt;64mmHg (OR=1.037) from the mean in the first 48 hours after successful MT were associated with poor MRS at 90 days. A SBP SD&gt;14 was also associated with mortality at 90 days. A higher age (OR=1.052) and NIHSS (OR=1.096) were also associated with a poor MRS at 90 days. A higher DBP mean (OR=1.045) was associated with a higher rate of hemorrhagic transformation (HT). Conclusions: A higher SBP variability within the first 48 hours after successful MT is associated with a higher likelihood of poor 90-day functional outcome and mortality, and a higher mean DBP is associated with a higher rate of HT.

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.

The impact of day-by-day blood pressure variability on neurological functional outcome after acute ischemic stroke

Abstract Background Increased blood pressure variability (BPV) might be a detrimental factor after acute ischemic stroke. Previous studies on the association between blood pressure variability in the acute ischemic stroke and neurological functional outcome have yielded inconsistent results. Purpose We aimed to investigate the impact of day-by-day blood pressure variability within 7 days of onset on neurological functional outcome at 3 months after acute ischemic stroke. Methods Total 367 patients hospitalized for ischemic stroke within 48 hours of onset were enrolled. The acute stage of ischemic stroke was defined as the time period from symptom onset to 7 days. During this period, day-by-day blood pressure variability, including standard deviation (SD) and coefficient variation (CV) were derived and compared to neurological functional outcome. A baseline severity-adjusted analysis was performed using 3-month modified Rankin Scale score as the neurological functional outcome. Unfavorable outcome was defined as mRS≥3. Results The patients with unfavorable outcome had significantly higher systolic BPV (within 7 days of onset) than those with favorable outcome (15.41±4.59 VS 13.42±3.95mmHg for SD, P&amp;lt;0.001; 11.54±3.23 VS 10.41±2.82 for CV, P=0.001). Multivariable logistic regression analysis revealed that Systolic BPV was significantly and independently associated with the 3-month neurological functional outcome (odds ratio [OR] = 1.15, 95% confidence interval [CI]: 1.07–1.22, P&amp;lt;0.001 for SD; OR=1.15, 95% CI: 1.06–1.26, P=0.001 for CV). In addition, After adjustment for multiple confounding factors, including age, gender, risk factors, stroke features, baseline severity, recanalized therapy, hemorrhagic transformation, pulmonary infection, white blood cell, estimated Glomerular Filtration Rate and mean BP, day-by-day BP variability was significantly correlated with an unfavorable outcome in the top versus bottom quartile of systolic BP variability (OR=3.33, 95% CI: 1.41–7.85, P=0.006 for SD; OR=2.27, 95% CI: 1.04–4.94, P=0.037 for CV) during 3-month follow-up. Similar trends were also observed for diastolic BP variability. More importantly, incorporating SD of systolic BP into the conventional prediction model significantly increased the AUC for prediction of 3-month unfavorable outcome after acute ischemic stroke (0.84 vs 0.86; P=0.041). Conclusions Increased day-by-day blood pressure variability of systolic or diastolic BP in the acute ischemic stroke was associated with higher risk for unfavorable outcome at 3 months independent of mean blood pressure. Combining SD of systolic BP with conventional risk factors could thus improve the prediction of unfavorable outcome. Funding Acknowledgement Type of funding source: None

Visit-to-Visit Blood Pressure Variability Is Associated With Cognitive Decline and Incident Dementia: The S.AGES Cohort.

To investigate the impact of visit-to-visit systolic blood pressure variability (BPV), diastolic BPV, mean arterial pressure variability, and pulse pressure variability on cognitive decline and incident dementia in noninstitutionalized patients aged ≥65 years. A total of 3319 subjects from the S.AGES (Sujets AGÉS-Aged Subjects) cohort underwent clinical examinations every 6 months during 3 years. Variability was evaluated using standard deviation (SD), coefficient of variation, average real variability, successive variation, variation independent of mean, and residual SD. Cognition was assessed using the Mini-Mental State Examination and dementia with the Diagnostic Statistical Manual of Mental Disorders. Linear mixed models and Cox proportional hazards models were used. Higher systolic BPV was associated with poorer cognition independently of baseline SBP: adjusted 1-SD increase of coefficient of variation: β (SE)=-0.12 (0.06), P=0.04. Similar results were observed for diastolic BPV and mean arterial pressure variability: β (SE)=-0.20 (0.06), P<0.001 for both. Higher pulse pressure variability was no longer associated with cognitive function after adjustment for age, except with residual SD (P=0.02). Among the 3319 subjects, 93 (2.8%) developed dementia. Higher systolic BPV was associated with greater dementia risk (adjusted 1-SD increase of coefficient of variation: hazard ratios=1.23 [95% CI, 1.01-1.50], P=0.04). Similar results were found for diastolic BPV and mean arterial pressure variability (P<0.01). Pulse pressure variability was not associated with dementia risk. Beyond hypertension, higher BPV is a major clinical predictor of cognitive impairment and dementia. Further studies are needed to assess whether controlling BP instability could be a promising interventional target in preserving cognition among older adults.

Abstract P170: Visit-to-visit Blood Pressure Variability Is Associated With Functional Decline In Older Adults: The S.ages Cohort

Objective: To investigate the impact of visit-to-visit systolic, diastolic, mean arterial pressure and pulse pressure variability on functional decline in non-institutionalized patients aged ≥ 65 years. Methods: 3042 subjects from the S.AGES (elderly subjects) cohort underwent clinical examinations every 6 months during 3 years. Systolic, diastolic, mean arterial pressure and pulse pressure variability were evaluated using standard deviation, coefficient of variation, average real variability, successive variation, variation independent of mean and residual standard deviation. Functional decline was assessed using the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scales and defined over time as any help required to perform at least one task. Cox proportional hazards models were used for the analyses. Results: Among the 3042 subjects, 527 (17.3%) had functional decline (ADL) over time. After adjustment for demographics, systolic blood pressure, antihypertensive drugs, coronary artery disease, diabetes mellitus, chronic heart failure, atrial fibrillation, transient ischemic attack or stroke, smoking, dyslipidemia and Mini Mental State Examination at baseline, higher systolic blood pressure variability was associated with greater risk of functional decline (ADL) (adjusted HR per 1-SD increase of coefficient of variation = 1.12, 95% CI [1.03-1.22], p&lt;0.01). Similar results were observed for diastolic blood pressure variability (adjusted HR = 1.11, 95% CI [1.01-1.22], p=0.03) and mean arterial pressure variability (adjusted HR = 1.15, 95% CI 1.05-1.25, p&lt;0.01). Higher pulse pressure variability was no longer significantly associated with functional decline after adjustment for age (p=0.6). Similar patterns were found with all indicators of variability and loss of autonomy defined using IADL. Conclusion: Higher blood pressure variability could be a novel risk factor for functional decline and controlling blood pressure instability a promising interventional target in preserving autonomy in older adults.