Higher Systolic Blood Pressure Variability Research Articles

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<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<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.

Abstract 157: High Systolic Blood Pressure Variability After Successful Reperfusion Therapy in Acute Ischemic Stroke Predicts Unfavorable Outcomes

Introduction: There has been increasing evidence that higher systolic blood pressure variability (SBPV) is related to unfavorable outcomes in patients with stroke. We explored the relation between SBPV and clinical outcomes after reperfusion therapy; intravenous thrombolysis (IVT) and endovascular therapy (EVT). Methods: We retrieved data of consecutive patients with acute ischemic stroke (AIS) treated with reperfusion therapy from our prospective stroke registry between October 2005 and December 2018. We calculated the following five SBPV during 24 hours after IVT or EVT; mean, standard deviation (SD), coefficient of variation (CV), successive variation (SV), and average real variability (ARV). Clinical outcomes included unfavorable outcomes as modified Rankin Scale (mRS) score 3-6 at 3 months and symptomatic intracranial hemorrhage (sICH) as any hemorrhage with neurological deterioration of 4 points of more on the National Institute of Health Stroke Scale (NIHSS). Successful reperfusion was indicated with early neurological improvements of 4 points of more on the NIHSS after IVT alone or Thrombolysis in Cerebral Infarction scores of 2b or 3 after EVT alone or EVT combined with IVT. Results: Among 933 patients with premorbid mRS scores of 0-1 (72±12 years; 316 women), 426 patients with unfavorable outcomes and 35 patients with sICH were observed. In adjusted analyses, all measures of SBPV but CV were related to unfavorable outcomes, while all measures of SBPV but mean SBP were related to sICH. In 566 patients with successful reperfusion, 228 patients with unfavorable outcomes and 10 patients with sICH were observed. In adjusted analyses, all measures of SBPV but mean SBP were positively related to unfavorable outcomes, while no measures of SBPV were independently related to sICH (table). Conclusion: High SBPV after successful reperfusion therapy contributed to unfavorable outcomes, suggesting high SBPV after reperfusion therapy might need more attention.

Abstract WP218: Increased Systolic Blood Pressure Variability Among Diabetic Patients is Associated With Higher Risk of Incident Stroke: A Secondary Analysis of ACCORDION

Background: Increased blood pressure variability (BPV) has been associated with stroke risk, but never specifically in patients with diabetes. Methods: This is a secondary analysis of the Action to Control Cardiovascular Risk in Diabetes Follow-On Study (ACCORDION), the long term follow-up extension of ACCORD. Visit-to-visit BPV was analyzed using all BP readings during the first 36 months. The primary outcome was incident ischemic or hemorrhagic stroke after 36 months. Differences in mean BPV was tested with Student’s t-test. We fit Cox proportional hazards models to estimate the adjusted risk of stroke across lowest vs. highest quintile of BPV and report hazard ratios along with 95% confidence intervals (CI). Results: Our analysis included 9,241 patients, with a mean (SD) age of 62.7 (6.6) years and 61.7% were male. Mean (SD) follow-up was 5.7 (2.4) years and number of BP readings per patient was 12.0 (4.3). Systolic, but not diastolic, BPV was higher in patients who developed stroke (Table 1). The highest quintile of SBP SD was associated with increased risk of incident stroke, independent of mean blood pressure or other potential confounders. (Table 2, Figure 1). There was no interaction between SBP SD and treatment arm assignment, although the interaction for glucose approached significance (Table 2). Conclusion: Higher systolic BPV was associated with incident stroke in a large cohort of diabetic patients. Future trials of stroke prevention may benefit from interventions targeting BPV reduction.

Blood Pressure Variability Predicts Poor In-Hospital Outcome in Spontaneous Intracerebral Hemorrhage.

Background and Purpose- There is increasing evidence that higher systolic blood pressure variability (SBPV) may be associated with poor outcome in patients with intracerebral hemorrhage (ICH). We explored the association between SBPV and in-hospital ICH outcome. Methods- We collected 10-years of consecutive data of spontaneous ICH patients at 2 healthcare systems. Demographics, medical history, laboratory tests, computed tomography scan data, in-hospital treatments, and neurological and functional assessments were recorded. Blood pressure recordings were extracted up to 24 hours postadmission. SBPV was measured using SD, coefficient of variation, successive variation (SV), range and 1 novel index termed functional SV. The effects of SBPV on the functional outcome at discharge were evaluated by multivariate logistic and ordinal regression analyses for dichotomous and trichotomous modified Rankin Scale categorizations, respectively. In secondary analyses, associations between SBPV, history of hypertension, and hematoma expansion were explored. Results- The analysis included 762 subjects. All 5 SBPV indices were significantly associated with the probability of unfavorable outcome (modified Rankin Scale score, 4-6) in logistic models. In ordinal models, SD, coefficient of variation, range, and functional SV were found to have a significant effect on the probabilities of poor (modified Rankin Scale score, 3-4) and severe/death (modified Rankin Scale score, 5-6) outcomes. Normotensive patients had significantly lower mean SBPV compared with the untreated-hypertension cohort for all SBPV indices and compared with treated-hypertension patients for 3 out of 5 SBPV indices. Lower mean SBPV of treated-hypertension subjects compared with untreated-hypertension subjects was only detected in the SV and functional SV indices (P=0.045). None of the SBPV indices were significantly associated with the probability of hematoma expansion. Conclusions- Higher SBPV in the first 24 hours of admission was associated with unfavorable in-hospital outcome among ICH patients. Further prospective studies are warranted to understand any cause-effect relationship and whether controlling for SBPV may improve the ICH outcome.

Abstract 93: Increased Blood Pressure Variability After Acute Ischemic Stroke Increases the Risk of Death

Introduction: Increased visit-to-visit blood pressure variability (BPV) is linked to a higher risk of incident ischemic stroke in large epidemiologic studies. Hypothesis: Increased BPV in the acute phase after ischemic stroke will be correlated with death and poor outcome. Methods: This is a secondary analysis of patients in the placebo arms of the Virtual Stroke International Stroke Trial Archive (VISTA) with 4 or 5 blood pressure readings in the 24 hours after enrollment. Our primary outcome is death and the secondary is poor outcome, defined as a modified Rankin Scale of 3 to 6, both at 90 days from enrollment. We calculated BPV using 6 statistical methodologies (Table 1) and compared the highest to lowest tercile for each measure of BPV. Results: We included 1,947 patients, of whom 907 (46.6%) were female and the mean±SD age was 69.7±12.3 years. The mean±SD time from stroke onset to study enrollment was 4.8±2.4 hours and 534 (27.4%) received intravenous tPA. Of the 1,947 patients, 332 (19%) died within 90 days and 1,125 had a poor outcome (58%). We found that higher systolic BPV had a robust association with all-cause death, but not poor outcome (Tables 1 & 2). Diastolic BPV had a less consistent association with either outcome. Conclusion: Increased BPV in the first day after acute ischemic stroke is associated with a higher risk of death within 90 days, in the VISTA database. Prospective studies can establish if this is causal or an epiphenomenon.

PP.06.32] VISIT-TO-VISIT BLOOD PRESSURE VARIABILITY AND ITS CORRELATION WITH DECLINE IN KIDNEY FUNCTION IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

Objective: Blood pressure variability (BPV) is associated with poorer outcomes in patients with diabetes. Research on the characteristics of visit-to-visit BPV and its prognostic implications is limited. This study aimed to determine the value of BPV, associated factors of systolic BPV and its correlation with decline in kidney function in patients with type 2 diabetes mellitus (T2DM). Design and method: This was a 10-year retrospective cohort study of 333 patients with T2DM at a primary care clinic. Blood pressure (BP) at every follow up visit from 2005 to 2014 were captured. BPV was defined as the standard deviation of the BP readings. Decline in kidney function was expressed as the annual rate of decline in estimated glomerular filtration rate (eGFR). Factors associated with visit-to-visit systolic BPV was determined using Pearson's correlation coefficient and independent t-test. Independent association of decline in annual eGFR rate was determined using multivariate linear regression analysis. Results: This study involved 112 male patients (33.6%) and 221 female patients (66.4%). The mean age of patients at baseline was 57.8 ± 9.5 years old. By the end of study period, the mean duration of years of diabetes was 15.9 ± 6.2 years and 298 (89.5%) of patients had co-morbid hypertension. The mean visit-to-visit systolic BPV was 12.7 ± 3.1 mmHg. Higher systolic BPV was found in patients who were older, females, with co-morbid hypertension, more frequent clinic visits, higher mean systolic BP, higher mean total cholesterol and users of antihypertensive medications. The mean annual decline in eGFR rate in this study was −0.78 ± 1.60 ml/min/1.73m2. Independent factors associated with decline in kidney function were systolic BPV, longer duration of diabetes and use of diuretics. Conclusions: The visit-to-visit standard deviation of BPV in patients with T2DM is 12.7 mmHg. Systolic BPV is an independent risk factor associated with decline in kidney function. Hence visit-to-visit BPV is an important additional target to reduce decline in kidney function in patients with T2DM.

Postoperative blood pressure variability exerts an influence on clinical outcome after coil embolization of ruptured intracranial aneurysms

Objective: The present study was conducted to evaluate the effect of postoperative blood pressure (BP) variability on functional outcome in patients after coil embolization of ruptured aneurysms.Methods: The authors retrospectively reviewed their database of patients undergoing endovascular coiling to treat subarachnoid hemorrhage (SAH) between November 2011 and December 2014. BP values were recorded every 2 hours in the initial 24 hours after endovascular obliteration of ruptured aneurysms. BP variability was determined as standard deviation (SD) and successive variation (SV). Clinical outcome at discharge was assessed by the modified Rankin Scale (mRS) and Glasgow Coma Scale (GCS) Score. BP variability obtained were correlated to patient outcome and analyzed statistically.Results: Favorable outcomes (mRS 0–1) achieved in 308 (83.7%) of the 368 patients. On univariate logistic analysis, postoperative systolic blood pressure variability (SBPV)-SD, SBPV-SV, diastolic blood pressure variability (DBPV)-SD and DBPV-SV were associated with clinical outcome at discharge. SBPV-SV remained to be an independent predictor for functional recovery (OR, 0.93; 95% CI, 0.88–0.98; P = 0.009) after adjusting for age, postoperative fever, and Hunt–Hess grade by multivariate analysis. Furthermore, patients with higher SBPV had lower GCS grade at discharge (P < 0.001). There was no association between clinical outcome and mean systolic BP (SBP) (P = 0.360) or mean diastolic BP (DBP) (P = 0.105) after coiling.Conclusion: Postoperative SBPV was a strong predictor of clinical outcome in patients undergoing coil embolization of aneurysms, independent of mean SBP or DBP and seemed to be a potential therapeutic target in aneurysmal SAH.

Relationship Between Visit-to-Visit Blood Pressure Variability (BPV) and Kidney Function in Patients with Hypertension

Background/Aims: To investigate the impact of kidney function (using estimated glomerular filtration rate, [eGFR]) on blood pressure variability (BPV) via a retrospective post hoc analysis of patients with hypertension enrolled in two large clinical trials. Methods: Subject-level data were extracted from ASCOT (N=18,852) and ALLHAT (N=26,441) databases; both were randomized, active controlled studies, with treatment duration for hypertension ≥4 years. Visit-to-visit BPV was assessed using the square root of the coefficient of variation of systolic blood pressure (SBP) across visits from 12 weeks onwards. Baseline GFR, estimated by the simplified Modification of Diet in Renal Disease equation, was stratified into ≤60, 61-90, and >90 mL/min/1.73 m². The relationship between baseline eGFR and systolic BPV was analyzed using an analysis of covariance, with baseline factors considered as covariates. Studies were pooled and analyzed individually. Results: Patient characteristics were largely consistent between studies. In the pooled population (n=38,133) there were 19.1%, 62.9%, and 18.0% patients, with eGFR ≤60, 61-90, and > 90 mL/min/1.73 m², respectively. Patients with lower baseline eGFR had higher systolic BPV, in the pooled population and the individual analyses. Other baseline predictors of high systolic BPV included high SBP and age, being male, and a smoker. An amlodipine-based regimen was a negative predictor of high systolic BPV, vs. other antihypertensives, regardless of eGFR. Conclusions: Patients with declining renal function tended to have higher systolic BPV vs. those without, even after adjusting for risk factors. Amlodipine-based therapy reduced BPV more than other antihypertensive agents, regardless of level of eGFR.

Abstract P105: Greater 24 Hour Blood Pressure Variability is Associated With Higher 24 Hour Systolic Blood Pressure and Glucose Independent of Age and Large Elastic Artery Stiffness in Normotensive Adults

Older age is associated with elevated large elastic artery stiffness, a strong predictor of cardiovascular (CVD) risk in middle-age/older (MA/O) adults independent of blood pressure (BP). Greater 24-hour systolic BP variability (BPV) is also an independent risk factor for CVD and is linked to large artery stiffness in MA/O adults with hypertension and diabetes. However, its relation to age-related arterial stiffness in adults with low risk factor burden is unclear. We hypothesized that higher systolic BPV would be: 1) associated with advancing age, and 2) related to elevated aortic and carotid artery stiffness among healthy MA/O adults. To determine this, 98 healthy adults (ages 19-70 yrs) with measurements of systolic BPV (standard deviation of 24 hr systolic BP) via ambulatory BP monitoring, aortic stiffness (carotid-femoral pulse wave velocity, cfPWV), carotid artery stiffness (β-stiffness via carotid tonometry/B mode ultrasound) and circulating metabolic factors were included. In the entire cohort, greater systolic BPV was not associated with age, cfPWV, carotid β stiffness or circulating lipids/glucose (all P&gt;0.05), but was correlated (age-adjusted) with 24 hr systolic BP (r= 0.41, P&lt;0.001) and BMI (r= 0.21, P&lt;0.05). In stepwise linear regression analyses that included age, sex, BMI, only 24 hr systolic BP was associated with systolic BPV (β= 0.14 ± 0.03, Model R 2 = 0.20, P&lt; 0.001). Interestingly, there was no difference in 24 hr systolic BPV (11.4 ± 0.4 vs 11.4 ± 0.5 SD mmHg, P=0.99) in young (n=55; 29.0 ± 0.7 yrs) vs. MA/O (n= 43; 53.0 ± 1.2 yrs) adults despite higher cfPWV (594 ± 12 vs 913 ± 39 cm/sec, P&lt;0.001), carotid β-stiffness (6.8 ± 0.6 vs 9.3 ±0.9 U, P=0.001) and 24 hr systolic BP (121 ± 1 vs 125 ± 2 mmHg, P&lt;0.05). Systolic BPV was associated with BMI (r= 0.42, p&lt; 0.01) and fasting blood glucose (r= 0.54, P= 0.001) in MA/O but not young adults. In a stepwise linear regression model among MA/O, 24 hr systolic BP (β= 0.18 ± 0.04, R 2 = 0.36, P&lt;0.001) and fasting glucose (β= 0.10 ± 0.05, R 2 change= 0.07, P&lt;0.001) were the only significant correlates of systolic BPV (Model R 2 = 0.43, P&lt;0.001). In conclusion, 24 hr systolic BP and fasting blood glucose, but not age or large elastic artery stiffness, were the strongest determinants of higher systolic BPV in normotensive MA/O adults.

PP.03.28

Objective: Emerging evidence now suggests that central pressure is better related to future cardiovascular events than brachial pressure. Visit-to-visit systolic blood pressure variability (SBPV) in treated hypertensive patients has adverse impact on prognosis and it stimulates searching for its predictors. The aim of the study was to evaluate SBPV and its associations with central blood pressure and arterial stiffness in controlled arterial hypertension. Design and method: 52 pts (20 men, age 58,9 ± 9,0 yrs; 4 smokers; 6 diabetics) were treated to target BP < 140/90mmHg with a RAAS-inhibitor/amlodipine combination for 14 months. Baseline BP was 163,4 ± 8,1/100,9 ± 4,2mmHg; achieved-123,7 ± 9,7/76,8 ± 6,7mmHg. SBPV was calculated as SD for 5 visits during 8 months after target BP achievement. Central BP and pulse wave velocity (PWV) were measured at baseline and in 14 months. p < 0,05 was considered significant. Results: SBPV range was 1,79–16,79 mmHg (tertile I < 5,38; II 5,38 - 7,78; III > 7,78 mmHg). The groups were similar by age (I 56,6 ± 8,94, II 59,4 ± 9, III 60,7 ± 9,1 yrs, p > 0,05), gender, metabolic risk factors, baseline and achieved BP (I 162,9 ± 8,7; II 164,0 ± 9,0; III 163,4 ± 7,0 mm Hg and I 122,9 ± 7,3; II 126,7 ± 8,8; III 121,6 ± 12,1 mm Hg, respectively). Higher SBPV was associated with higher baseline central SBP (I 134,6 ± 15,8; II 132,6 ± 15,9 and III 146,1 ± 17,7 mm Hg) and higher baseline central PP (47,2 ± 10,6, 55,6 ± 11, 51,1 ± 11,5 mmHg, respectively), p < 0,05 for both trends. Number of patients with baseline central SBP>Median (140 mmHg) was 66,7%, 35,3% and 41,2% for corresponding tertiles of SBPV (Pearson‘s χ2 = 4,9; p < 0,05) No correlation was found between SBPV and any other characteristics, including baseline central SBP. No significant difference was found for PWV (13 ± 1,6, 14,2 ± 2,2, 12,9 ± 1,8 m/s, respectively). Conclusions: Higher central SBP and PP despite similar levels of brachial BP may predict higher visit-to-visit SBPV in controlled hypertension. This finding confirms possible association of BPV and arterial stiffness and remodelling.

Blood Pressure Variability and Cardiovascular Risk in the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER)

Variability in blood pressure predicts cardiovascular disease in young- and middle-aged subjects, but relevant data for older individuals are sparse. We analysed data from the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER) study of 5804 participants aged 70–82 years with a history of, or risk factors for cardiovascular disease. Visit-to-visit variability in blood pressure (standard deviation) was determined using a minimum of five measurements over 1 year; an inception cohort of 4819 subjects had subsequent in-trial 3 years follow-up; longer-term follow-up (mean 7.1 years) was available for 1808 subjects. Higher systolic blood pressure variability independently predicted long-term follow-up vascular and total mortality (hazard ratio per 5 mmHg increase in standard deviation of systolic blood pressure = 1.2, 95% confidence interval 1.1–1.4; hazard ratio 1.1, 95% confidence interval 1.1–1.2, respectively). Variability in diastolic blood pressure associated with increased risk for coronary events (hazard ratio 1.5, 95% confidence interval 1.2–1.8 for each 5 mmHg increase), heart failure hospitalisation (hazard ratio 1.4, 95% confidence interval 1.1–1.8) and vascular (hazard ratio 1.4, 95% confidence interval 1.1–1.7) and total mortality (hazard ratio 1.3, 95% confidence interval 1.1–1.5), all in long-term follow-up. Pulse pressure variability was associated with increased stroke risk (hazard ratio 1.2, 95% confidence interval 1.0–1.4 for each 5 mmHg increase), vascular mortality (hazard ratio 1.2, 95% confidence interval 1.0–1.3) and total mortality (hazard ratio 1.1, 95% confidence interval 1.0–1.2), all in long-term follow-up. All associations were independent of respective mean blood pressure levels, age, gender, in-trial treatment group (pravastatin or placebo) and prior vascular disease and cardiovascular disease risk factors. Our observations suggest variability in diastolic blood pressure is more strongly associated with vascular or total mortality than is systolic pressure variability in older high-risk subjects.

Control of cardiovascular variability during undisturbed wake-sleep behavior in hypocretin-deficient mice

The central neural mechanisms underlying differences in cardiovascular variability between wakefulness, non-rapid-eye-movement sleep (NREMS), and rapid-eye-movement sleep (REMS) remain poorly understood. These mechanisms may involve hypocretin (HCRT)/orexin signaling. HCRT signaling is linked to wake-sleep states, involved in central autonomic control, and impaired in narcoleptic patients. Thus, we investigated whether HCRT signaling plays a role in controlling cardiovascular variability during spontaneous behavior in HCRT-deficient mice. HCRT-ataxin3 transgenic mice lacking HCRT neurons (TG), knockout mice lacking HCRT peptides (KO), and wild-type controls (WT) were instrumented with electrodes for sleep recordings and a telemetric blood pressure transducer. Fluctuations of systolic blood pressure (SBP) and heart period (HP) during undisturbed wake-sleep behavior were analyzed with the sequence technique, cross-correlation functions, and coherent averaging of SBP surges. During NREMS, all mice had lower SBP variability, greater baroreflex contribution to HP control at low frequencies, and greater amplitude of the central autonomic and baroreflex changes in HP associated with SBP surges than during wakefulness. During REMS, all mice had higher SBP variability and depressed central autonomic and baroreflex HP controls relative to NREMS. HP variability during REMS was higher than during NREMS in WT only. TG and KO also had lower amplitude of the cardiac baroreflex response to SBP surges during REMS than WT. These results indicate that chronic lack of HCRT signaling may cause subtle alterations in the control of HP during spontaneous behavior. Conversely, the integrity of HCRT signaling is not necessary for the occurrence of physiological sleep-dependent changes in SBP variability.

Abstract 2802: Age and Stroke Severity Influence the Association between Blood Pressure Variability and Stroke Recovery

Blood pressure elevations after ischemic stroke are regarded as the body's response to maintain cerebral perfusion. Extremes of blood pressure have correlated with poor stroke recovery. Recently, blood pressure variability was shown to predict outcome better than mean blood pressures. Variables such as age, National Institute of Health stroke scale (NIHSS) and diabetes are established predictors of poor outcome and may potentially affect the degree of blood pressure variability. Our hypothesis was that age, NIHSS and diabetes would influence the association between blood pressure variability and stroke recovery. Methods: a retrospective chart review of consecutive patients discharged with an acute ischemic stroke based on ICD-9 codes was conducted. Successive blood pressure recordings during the 1st 5 days of hospitalization were noted. Blood pressure variability was calculated for systolic, diastolic and mean arterial pressures separately using published methods. Demographics, comorbidities, and modified Rankin score (mRS) at discharge were abstracted. Results: The study included 295 stroke patients, (median age 60 years; median NIHSS of 4.0). Age &gt;60, NIHSS 4-9, NIHSS ≥ 10 and diabetes were associated with poor recovery (mRS 3-6). The mean pressures in the study group ranged from 105-195 mmHg for systolic blood pressure (SBP), 51-159 mm Hg for diastolic blood pressure and 70-163 mm Hg for mean arterial pressure. The median variability for SBP was 21.0mmHg; diastolic blood pressure was 12.7mmHg; mean arterial pressure was 13.6mmHg. Subjects with higher SBP variability (greater than the median of 21.0) had significantly higher rates of poor recovery. Stratifying by age, the association of SBP variability and poor outcome was significant for age &gt; 60(OR: 2.16; 95%CI 1.06-4.38) but not for the younger subgroup with age≤ 60. Stratifying by stroke severity, the association of SBP variability and poor recovery was significant for NIHSS 4-9 (OR 3.41; 95%CI 1.55-8.23). All patients with high SBP variability in the NIHSS ≥ 10 group had poor recovery. The association was also significant in the subgroup without diabetes (OR 1.97; 95%CI 1.10-3.51), not in the subgroup of diabetic patients. Overall, the odds of a poor recovery due to high SBP variability were highest among subjects &gt; 60 years with moderate to high NIHSS. Conclusions: SBP variability in acute ischemic stroke is especially harmful among the elderly, nondiabetic and the more severe strokes. Extreme caution is advised when prescribing blood pressure lowering medications in these subgroups.

Effect of occupational stress on ambulatory blood pressure

To explore the effect of occupational stress on ambulatory blood pressure. 30 male healthy workers from the refrigerator assembly line in Henan province in China were investigated. Psychosocial work conditions were measured by using the Job Demand-control Model, the Effort-reward Imbalance Model questionnaires and Occupational Stress Measurement Scale. Ambulatory blood pressure(ABP) was measured by using mobile ABP monitor. The t test was utilized to analyze the difference of parameters of ABP monitoring between different groups of occupational stress and other variables scores. The stepwise regression analysis was used to analyse the effect of occupational stress factors on parameters of ABP. (1) As to stressors, systolic blood pressure variability (SBPV), mean arterial blood pressure variability (MABPV) and heart rate at 30 minute after work in workers with high role conflict score were significantly higher than those in workers with low score (P < 0.05). Workers with high skill utilization score had significantly lower mean systolic blood pressure (SBP) at 30 minute after work than workers with low score (P < 0.05). Diastolic blood pressure variability (DBPV) and heart rate variability (HRV) in workers with high decision latitude score were significantly higher than those in workers with low score (P < 0.05). Workers with high job psychological demands score had significantly higher SBPV, DBPV and MABPV than workers with low score (P < 0.05). Heart rate-pressure product(RPP) and SBPV in workers with high effort score were significantly higher than those in workers with low score (P < 0.05). Workers with low rewards score had higher mean heart rate and heart rate at 30 minute after work than workers with high score (P < 0.05). (2) For personalities, workers with high work locus of control score had significantly higher mean diastolic blood pressure (DBP) and mean arterial blood pressure (MABP) than workers with low score (P < 0.05). Workers with high patience score had significantly lower mean SBP at 30 minute after work than workers with low score (P < 0.05). Heart rate at 30 minute after work in workers with high organization commitment score was significantly lower than that in workers with low score (P < 0.05). (3) Concerning buffer factors, HRV in workers with high control strategies score were significantly lower than that in workers with low score (P < 0.05). Workers with low supervisor support score had higher RPP and MABPV than workers with high score (P < 0.05). (4) In the multiple stepwise regression, daily life stress affected SBPV (R2 = 0.12) and MABPV (R2 = 0.05), depression was related to DBPV at 30 minute after work (R2 = 0.15) and SBPV (R = 0.03), mental health was predictor of MABPV (R2 = 0.07) and negative affection was predictor of heart rate at 30 minute after work (R2 = 0.24). Occupational stressors, personality and social support have effect on parameters of ABP. Parameters of ABP monitoring could be used to evaluate occupational stress in the field research.