Systolic Blood Pressure Variability Research Articles

Abstract P405: Calibrating Routine Blood Pressures Among Preterm Infants: A Retrospective, Cross-Sectional Analysis

Background: Among preterm infants (< 12 months postnatal age and born < 37 weeks gestation), oscillometric systolic blood pressure (SBP) measurements are error-prone. However, some preterm infants have “gold standard” SBPs measured using an arterial line, in addition to the error-prone oscillometric SBPs. Objective: To compare different statistical methods to calibrate oscillometric SBPs to mimic arterial line SBPs Methods: We sampled participants from an existing pilot study of preterm infants treated with an antihypertensive therapy at the University of Alabama at Birmingham. Participants' data was obtained from the hospital's data warehouse for electronic medical records. Participants for this analysis had at least one arterial line SBP measurement, and for each of these "gold standard" measurements we identified the closest paired oscillometric SBP measurement (<10 minutes apart). We also collected participant factors such as race (white vs. black/African American), gender, gestational age at birth (weeks), postnatal age at arterial line SBP measurement (weeks), and whether the participant had received an antihypertensive medication. We predicted the arterial line SBPs from oscillometric SBPs and covariates using linear regression, linear regression with restricted cubic splines, random forest, and Bayesian additive regression trees (BART). Prediction errors were calculated using 10-fold cross-validation. We used complete case analysis. Results: We identified 822 measurements among 28 participants. Ten of 28 (36%) participants were black and 13 of 28 (46%) were female. The median (Q1, Q3) gestational age at birth was 33 (29, 35) weeks. The root mean squared error for predicting arterial line SBP from oscillometric SBP by itself was 17.1 mmHg. The root mean squared error of the predicted arterial line SPBs from different statistical methods varied little from the most error (linear regression with restricted cubic splines: 13.5 mmHg) to the least error (BART: 12.6 mmHg), meaning that any calibration resulted in at least a 21% reduction in error compared to the oscillometric SBPs. BART tended to underpredict the arterial line SBPs that were above 100 mmHg. Conclusions: Among preterm infants, statistical calibration is a viable strategy for reducing the variability of error-prone oscillometric SBPs. The different statistical models performed similarly in this small pilot study, but a larger sample size using additional important variables (e.g., birth weight) is required to confirm this finding.

Visit-to-visit blood pressure variability is associated with intrinsic capacity decline: Results from the MAPT Study

BackgroundThe effectiveness of the body physiological regulatory mechanisms declines in late life, and increased Blood Pressure Variability (BPV) may represent an alteration in cardiovascular homeostatic patterns. Intrinsic Capacity (IC) has been proposed by the World Health Organization as a marker of healthy aging, based on individual's functional abilities and intended at preserving successful aging. We aimed to investigate the association of visit-to-visit BPV with IC decline in a population of community-dwelling older adults. MethodsThe study population consisted of 1407 community-dwelling participants aged ≥70 years from the MAPT study evaluated during the 5-year follow-up. Systolic BPV (SBPV) and diastolic BPV (DBPV) were determined through six indicators. Cognition, psychology, locomotion and vitality constituted the four IC domains assessed. Total IC Z-score resulted from the sum of the four domains Z-scores divided by 4. The incidence of domain impairment over time was also assessed. ResultsHigher SBPV was significantly associated with poorer IC Z-scores in all linear mixed models [1-SD increase of CV%: β(SE)=−0.010(0.001), p < 0.01]. Similar results were observed for DBPV [1-SD increase of CV%: β(SE)=−0.003(0.001), p = 0.02]. Incident IC impairment was significantly higher in participants with greater SBPV, [HR=1.16 (95 % CI, 1.01–1.33), p = 0.03], while greater DBPV did not show a higher risk of incident IC impairment. ConclusionsGreater BPV is associated with IC decline over time. Our findings support BP instability as a presumable index of altered cardiovascular homeostatic mechanism, suggesting that BPV might be a clinical marker of aging and addressable risk factor for promoting healthy aging.

Visit-to-visit blood pressure variability and progression of white matter hyperintensities over 14 years

Purpose: There is evidence that blood pressure variability (BPV) is associated with cerebral small vessel disease (SVD) and may therefore increase the risk of stroke and dementia. It remains unclear if BPV is associated with SVD progression over years. We examined whether visit-to-visit BPV is associated with white matter hyperintensity (WMH) progression over 14 years and MRI markers after 14 years. Materials and methods: We included participants with SVD from the Radboud University Nijmegen Diffusion tensor Magnetic resonance-imaging Cohort (RUNDMC) who underwent baseline assessment in 2006 and follow-up in 2011, 2015 and 2020. BPV was calculated as coefficient of variation (CV) of BP at all visits. Association between WMH progression rates over 14 years and BPV was examined using linear-mixed effects (LME) model. Regression models were used to examine association between BPV and MRI markers at final visit in participants. Results: A total of 199 participants (60.5 SD 6.6 years) who underwent four MRI scans and BP measurements were included, with mean follow-up of 13.7 (SD 0.5) years. Systolic BPV was associated with higher progression of WMH (β = 0.013, 95% CI 0.005 − 0.022) and higher risk of incident lacunes (OR: 1.10, 95% CI 1.01–1.21). There was no association between systolic BPV and grey and white matter volumes, Peak Skeleton of Mean Diffusivity (PSMD) or microbleed count after 13.7 years. Conclusions: Visit-to-visit systolic BPV is associated with increased progression of WMH volumes and higher risk of incident lacunes over 14 years in participants with SVD. Future studies are needed to examine causality of this association.

Significance of blood pressure variability in normotensive individuals as a risk factor of developing hypertension

Purpose Visit-to-visit blood pressure variability is a strong predictor of the incidence of cardiovascular events and target organ damage due to hypertension. The present study investigated whether year-to-year blood pressure variability predicts the risk of hypertension in the Japanese general population. Materials and methods This study analysed 2806 normotensive individuals who participated in our physical check-up program for five years in a row from 2008 to 2013. The average, standard deviation, coefficient of variation, average real variability, and highest value of systolic blood pressure in the five consecutive visits were determined and used as baseline data. The participants were followed up for the next 6 years with the development of ‘high blood pressure’, an average blood pressure level of ≥140/90 mmHg or the use of antihypertensive medications, as the endpoint. Result During follow-up, ‘high blood pressure’ developed in 389 participants (13.9%, 29.5 per 1 000 person-years). The incidence increased across the quartiles of standard deviation and average real variability, while the average and highest systolic blood pressure had the most prominent impact on the development of ‘high blood pressure’. Multivariate logistic regression analysis adjusted for possible risk factors indicated that the average, standard deviation, average real variability, and highest blood pressure, but not the coefficient of variation of systolic blood pressure, were significant predictors of ‘high blood pressure’. Conclusion Increased year-to-year blood pressure variability predicts the risk of hypertension in the general normotensive population. The highest blood pressure in the preceding years may also be a strong predictor of the risk of hypertension.

Association between trajectories of systolic blood pressure and frailty outcome in middle-aged and older adults

ObjectivesThe association between blood pressure and frailty outcome in the middle-aged and older population remains controversial. This study aimed to examine the relationship between trajectories of systolic blood pressure (SBP) and new-onset frailty. DesignCohort study with a 7-year follow-up. SETTING AND PARTICIPANTSData were derived from 4 waves (2011, 2013, 2015 and 2018) of the China Health and Retirement Longitudinal Study and 6168 participants aged ≥45 years were included in the study. MethodsThe frailty index (FI) was constructed based on 40 scored items, with FI ≥ 0.25 defined as frailty. We identified the 5-year trajectory of SBP by latent class trajectory modeling. The association between SBP trajectories and frailty was explored based on hazard ratios (HR) by four Cox proportional hazards models. Furthermore, we also investigated the relationship between mean SBP and systolic blood pressure variability (SBPV) and frailty. Results6168 participants were included in this study with a mean age of 59 years. We identified five trajectories based on SBP, which are maintained low-stable SBP (T0), moderate-stable SBP (T1), remitting then increasing SBP (T2), increasing then remitting SBP (T3), and remaining stable at high SBP levels (T4). During the 7-year follow-up period, frailty outcome occurred in 1415 participants. After adjusting for other confounders, the two trajectories labeled “T2” and “T4” were associated with a higher risk of frailty compared with T0. In addition, elevated SBP and increased SBPV were associated with risk of frailty. ConclusionsHigher risk of frailty occurred in two trajectories, remitting then increasing and remaining stable at high SBP levels, were associated with a relatively higher risk of frailty.

Association of body mass index and blood pressure variability with 10-year mortality and renal disease progression in type 2 diabetes

BackgroundVariability in biological parameters may be associated with adverse outcomes. The aim of the study was to determine whether variability in body mass index (BMI) and blood pressure is associated with all-cause, cardiovascular mortality and cancer mortality or with renal disease progression in subjects with type 2 diabetes.MethodsThe diabetes database was accessed, and all the information on patient visits (consultations) carried out in the study period (1 January 2008–31 December 2019) was extracted and linked to the laboratory database and the mortality register.ResultsThe total number of patients included in the study population was 26,261, of whom 54.4% were male. Median (interquartile range, IQR) age was 60.2 (51.8–68.3) years. The coefficient of variability of BMI was independently associated with increased all-cause and cardiovascular, but not cancer, mortality. Glycated haemoglobin (HbA1c) was associated with increased all-cause, cardiovascular, and cancer mortality as well as with renal progression. Variability in systolic blood pressure, diastolic blood pressure, and pulse pressure was associated with increased all-cause and cardiovascular mortality in bivariate, but not in multivariate, analyses.ConclusionsVariability in BMI was associated with increased all-cause and cardiovascular, but not cancer, mortality in a large real-world contemporary population. Our results also confirm the association of HbA1c with increased all-cause, cardiovascular, and cancer mortality as well as with renal progression.

The severity of chronic heart failure and the parameters of daily blood pressure profile in patients with coronary heart disease

Aim: Although the prevalence of coronary heart disease (CHD) and hypertension which are the most common causes of the development and progression of chronic heart failure (CHF) is high, 24-hour ambulatory blood pressure (BP) monitoring (ABPM) in patients with CHF is not mandatory to be performed. The growing number of evidence suggests that excessive decrease in BP which clearly reflects increased BP variability (BPV) affects the survival of patients with heart failure (HF). The objective of the study was to investigate the relationship between the parameters specific to CHF severity and features of daily BP profiles in patients with ischemic CHF and hypertension. Methods: Ninety patients with functional class II–IV of CHF and CHD (the main group) and 50 non-CHF patients with hypertension (the comparative group) were examined. The transthoracic echocardiography (TTE) [atrial end-systolic dimension (ESD), ventricular end-diastolic dimension (EDD), left ventricular mass index (LVMI), and left ventricular ejection fraction (LVEF)] and 24-hour ABPM (BPV parameters and proportions of hypotensive episodes) were performed. The relationships between the abovementioned parameters were evaluated using the univariate correlation analysis and stepwise multiple linear regression. Results: Higher functional class of CHF is found to be associated with a higher incidence of daytime systolic BP (SBP) decline and nighttime SBP and diastolic BP (DBP) variability while higher LVEF is related to the hypotensive episodes regardless of CHF. Conclusions: It appears that the larger trials involving CHF patients with reduced LVEF should be conducted to clarify the obtained results.

Associations of variability in blood glucose and systolic blood pressure with mortality in patients with coronary artery disease: A retrospective cohort study from the MIMIC-IV database

AimsVariability of metabolic parameters, such as glycemic variability (GV) and systolic blood pressure variability (SBPV), are associated with adverse cardiovascular outcomes. However, whether these parameters have additive effects on mortality in patients with coronary artery disease (CAD) hospitalized in the intensive care unit (ICU) remains unclear. MethodsWe retrospectively enrolled patients with CAD from the Medical Information Mart for Intensive Care-IV database. The highest tertile of variability was defined as high variability. A variability scoring system was established, which assigned 0 points to tertile 1, 1 point to tertile 2, and 2 points to tertile 3 for GV and SBPV. ResultsAmong 4237 patients with CAD, 400 patients died in hospital, and 967 patients died during 1-year follow-up. High GV and high SBPV were associated with an increased risk of mortality. The effects of GV and SBPV on in-hospital mortality were partially mediated by ventricular arrhythmias (18.0 % and 6.6 %, respectively). The risk of mortality gradually increased with the number of high-variability parameters and increasing variability scores. ConclusionsGV and SBPV have additive effects on the risk of mortality in patients with CAD hospitalized in the ICU. Ventricular arrhythmias partially mediate the effects of GV and SBPV on in-hospital mortality.

Enhancing blood pressure management protocol implementation in patients with acute intracerebral haemorrhage through a nursing-led approach: A retrospective cohort study.

To evaluate the impact of nurse care changes in implementing a blood pressure management protocol on achieving rapid, intensive and sustained blood pressure reduction in acute intracerebral haemorrhage patients. Retrospective cohort study of prospectively collected data over 6 years. Intracerebral haemorrhage patients within 6 h and systolic blood pressure ≥ 150 mmHg followed a rapid (starting treatment at computed tomography suite with a target achievement goal of ≤60 min), intensive (target systolic blood pressure < 140 mmHg) and sustained (maintaining target stability for 24 h) blood pressure management plan. We differentiated six periods: P1, stroke nurse at computed tomography suite (baseline period); P2, antihypertensive titration by stroke nurse; P3, retraining by neurologists; P4, integration of a stroke advanced practice nurse; P5, after COVID-19 impact; and P6, retraining by stroke advanced practice nurse. Outcomes included first-hour target achievement (primary outcome), tomography-to-treatment and treatment-to-target times, first-hour maximum dose of antihypertensive treatment and 6-h and 24-h systolic blood pressure variability. Compared to P1, antihypertensive titration by stroke nurses (P2) reduced treatment-to-target time and increased the rate of first-hour target achievement, retraining of stroke nurses by neurologists (P3) maintained a higher rate of first-hour target achievement and the integration of a stroke advanced practice nurse (P4) reduced both 6-h and 24-h systolic blood pressure variability. However, 6-h systolic blood pressure variability increased from P4 to P5 following the impact of the COVID-19 pandemic. Finally, compared to P1, retraining of stroke nurses by stroke advanced practice nurse (P6) reduced tomography-to-treatment time and increased the first-hour maximum dose of antihypertensive treatment. Changes in nursing care and continuous education can significantly enhance the time metrics and blood pressure outcomes in acute intracerebral haemorrhage patients. STROBE guidelines. No Patient or Public Contribution.

Prognostic value of blood pressure in the acute period of hemispheric ischemic stroke

Aim. To study changes in blood pressure (BP) in patients with acute hemispheric ischemic stroke (AIS), to correlate BP in patients with AIS with BP in patients with chronic brain ischemia, and to study the association of various BP indices with stroke severity and recovery.Material and methods. We included 235 patients with hemispheric AIS (age 64±11 years; women, 41,3%). BP was assessed 6 times as follows: by patient’s self-measurement during the month before the stroke onset, in the ambulance, in the admission department, in the intensive care unit using 24-hour blood pressure monitoring (BPM), in the neurologic department (BPM), and 90 days after stroke. In patients with chronic cerebral ischemia (178 patients, age 62±13 years, 46,1% women), BP was assessed 3 times: by patient’s self-measurement during the month before hospitalization, in the admission department, and in the neurologic department (BPM).Results. Patients with AIS within the month before stroke had higher systolic and pulse pressure than patients with chronic cerebral ischemia. During the acute stroke period, patients with AIS despite reaching target systolic and diastolic BP had significantly increased variability of systolic and diastolic BP compared to patients with chronic brain ischemia. Systolic BP ≥160 mm Hg recorded consecutively in ambulance, in admission department, and in intensive care unit, as well as pulse pressure ≥60 mm Hg, and systolic BP variability ≥18 mm Hg recorded on day 1-2 and day 9-10, positively correlated with National Institute of Health Stroke Scale (NIHSS) score (r≥0,37, p≤0,0017) on day 10 and with modified Rankin Scale (mRS) score (r≥0,29, p≤0,006) on day 90.Conclusion. Patients with hemispheric AIS had significantly higher systolic BP and pulse pressure within the month before stroke. During the first 10 days of AIS persistent increase in systolic, diastolic, and pulse pressure, and BP variability was associated with more severe stroke and less favorable outcome. These results should be taken into account when administering antihypertensive treatment.

Respuesta hemodinámica a dosis subanestésicas de ketamina en dolor posoperatorio: revisión sistemática

Introduction: Low-dose ketamine infusions have shown analgesic effectiveness for the management of postoperative pain. The impact of low-dose ketamine infusions on cardiovascular response is dose-dependent and requires a better knowledge about its effects on this population.&#x0D; Objective: To conduct a systematic review to describe changes in systolic, diastolic and mean arterial pressure, and heart rate 24, 48 and 72 hours after surgery.&#x0D; Methods: Randomized, controlled trials were reviewed in the Cochrane Library, PubMed, EMBASE, SciELO, Lilacs and grey literature on low-dose ketamine infusions for the study variables. The quality of the studies was assessed using the Cochrane’s risk of bias tool.&#x0D; Results: Six randomized, controlled trials with 641 patients were included. Low-quality evidence was found suggestive of a lack of certainty of any significant differences in the systolic blood pressure variables at 24 hours (mean standard deviation -1.00, 95 % CI: -7.27 to 5.27). A statistically significant higher mean heart rate at 24 hours was identified in the low-dose ketamine infusion group, (mean standard deviation 1.64 95 % CI: 0.38 to 2.90) which did not reach clinical significance. A lower pain level and less use of opioids was identified in the low-dose ketamine infusion group.&#x0D; Conclusion: Low quality evidence was found, suggesting that low-dose ketamine infusions are not associated with significant changes in blood pressure or heart rate 24 – 48 hours after surgery. It is important to individualize cardiovascular risk for each case, before initiating treatment.

24-Hour Blood Pressure Variability Via Ambulatory Monitoring and Risk for Probable Dementia in the SPRINT Trial

BackgroundBlood pressure variability is an emerging risk factor for dementia, independent and oftentimes beyond mean blood pressure levels. Recent evidence from interventional cohorts with rigorously controlled mean blood pressure levels suggest blood pressure variability over months to years remains a risk for dementia, but no prior studies have investigated relationships with blood pressure variability over shorter time periods.ObjectivesTo investigate the potential effect of ambulatory blood pressure variability on the rate of cognitive outcomes under intensive vs standard blood pressure lowering.DesignPost hoc analysis of the randomized, controlled, open-label Systolic Blood Pressure Intervention Trial clinical trial.SettingMultisite Systolic Blood Pressure Intervention Trial.Participants793 participants at increased risk for cardiovascular disease and without history of dementia at study randomization.InterventionStandard (<140 mmHg systolic blood pressure target) vs intensive (<120 mmHg systolic blood pressure target) lowering of mean blood pressure.Measurements24-hour ambulatory blood pressure monitoring 27 months after treatment randomization (standard vs intensive) and follow-up cognitive testing. Intraindividual blood pressure variability was calculated as the average real variability over 24-hour, daytime, and nighttime periods. Participants were categorized into 3 adjudicated clinical outcomes: no cognitive impairment, mild cognitive impairment, probable dementia. Cox proportional hazards models examined the potential effect of ambulatory blood pressure variability on the rate of cognitive outcomes under intensive vs standard blood pressure lowering. Associations with mean blood pressure were also explored.ResultsHigher systolic 24-hour blood pressure variability was associated with increased risk for probable dementia in the standard group (adjusted hazard ratio [HR]: 2.56 [95% CI 1.16, 5.62], p = 0.019) but not in the intensive group (HR: 0.54 [95% CI 0.24, 1.23], p = 0.141). Similar findings were observed with daytime systolic blood pressure variability but not nighttime blood pressure variability. Mean blood pressure was not associated with cognitive outcomes.ConclusionsHigher systolic 24-hour and daytime blood pressure variability via ambulatory monitoring is associated with risk for dementia under standard blood pressure treatment. Findings support prior evidence that blood pressure variability remains a risk for dementia despite strict control of mean blood pressure levels.

Abstract TP152: Systolic Blood Pressure Variability Characteristics Increase With Severity Among Intracerebral Hemorrhage Patients

Introduction: Selected studies link high systolic blood pressure variability (SBPV) to poor patient outcome after intracerebral hemorrhage (ICH). SBPV levels during real-world ICH admission remain unknown, however. We profile SBPV across ICH patient characteristics. Methods: Clinical data for adult patients (≥18) with primary non-traumatic ICH were retrieved from the electronic medical records. Patient SBPV was calculated as the Coefficient of Variation (CV; CV = (Standard Deviation/Mean)*100) during the first 24 hours of admission and across whole hospitalization. Hemorrhage characteristics and cerebral small vessel disease burden (CSVD; STRIVE 2.0 criteria) were assessed from neuroimaging during admission. Severe CSVD was assessed at summary scores ≥3. Cerebral Amyloid Angiopathy (CAA) was graded via Modified Boston Criteria. Descriptive statistics are provided for SBPV during first 24 hours of admission and whole-stay. Population differences are assessed using Mann Whitney Rank Sum and Kruskal Wallis tests of hypothesis. Results: Patient cohort included 2,020 primary ICH patients (median age: 67, IQR: [55-77]; 45.2% female), with an ethno-racial distribution of 43.6% White, 23.3% Black, 22.5% Hispanic, 8.2% Asian, and 2.5% Other. Median hemorrhage volume was 12.1 [1.9-36.3] cm 3 ; SBPVs over the first 24-hours and whole-stay were 12.6 [9.9-16.2] (Mean: 13.7; Skewness: 1.9; Kurtosis; 11.3) and 12.5 [10.7-15.0] (Mean: 13.4; Skewness: 3.05; Kurtosis; 21.3), respectively. SBPV significantly increased with female sex, worsening discharge disposition, increasing Glasgow Coma Scale severity, hemorrhage volume, intraventricular hemorrhage presence, and severe CSVD. Increasing CAA tiers showed reductions in SBPV. (Figure 1) Discussion: Levels of SBPV during ICH vary across patient characteristics and are elevated in those with more severe hemorrhage characteristics and worse hospital outcomes.

Abstract 148: Increased Systolic Blood Pressure Variability During the First 24-hours of Hospitalization Associates With Poor 90-day Outcome After Intracerebral Hemorrhage

Introduction: Prospective studies and secondary analyses from clinical trials have identified increased systolic blood pressure variability (SBPV) as a risk factor for poor outcomes. Evidence of this association in real-world intracerebral hemorrhage (ICH) hospitalization is lacking, however. Methods: Data for adult (≥18) patients with primary ICH were retrieved from the REINAH cerebrovascular research database. Systolic blood pressure measurements from the first 24 hours of admission were retrieved and SBPV was calculated as the Coefficient of Variation (CV) = (standard deviation/mean)*100. Socioeconomic deprivation was assessed using the state Area Deprivation Index (ADI), with high deprivation assessed at ADI ≥ 8. The primary outcome was severe disability or death (SDD; modified Rankin Scale ≥4) at 90-days after discharge. Differences in SBPV across SDD were assessed using the Mann-Whitney U test. Associations between SBPV and SDD were assessed using multivariable logistic regression models adjusted for patient characteristics. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) are reported. Results: Final cohort included 807 patients (median [IQR]: 66 [54-77], 45.6% female), with an ethno-racial distribution of 41.9% White, 25.9% Black, 23.9% Hispanic, 5.7% Asian, and 2.6% Other. The median CV was 12.07 [9.50-15.59] and 485 (60.1%) patients experienced SDD. Patients with SDD showed significantly higher SBPV than non-SDD patients (12.90 [10.33-17.11] vs 10.99 [8.72-13.72]; p&lt;0.001). Patients with 24-hour SBPV in the 3 rd (1.86 [1.16-2.96]) and 4 th quartile (3.10 [1.89-5.09]) had higher independent odds of SDD (vs. 1 st quartile) (Figure 1). Discussion: Patients with high SBPV during the first 24 hours of admission have higher odds of severe disability or death at 90-days after discharge.

Abstract 51: Impact of Cerebral Autoregulation on the Relationship Between Blood Pressure Variability and Functional Outcome Following Endovascular Thrombectomy

Background: Both increased blood pressure (BP) variability and impaired autoregulation have been linked to worse outcome after endovascular thrombectomy (EVT). This study examined the combined effect of these variables on the risk of poor outcome in patients with large-vessel occlusion (LVO) stroke. Methods: Autoregulation was continuously measured for up to 24 hours after EVT and quantified as a moving correlation coefficient between arterial BP and the near-infrared spectroscopy-derived cerebral oxygen saturation. Systolic BP variability was assessed using the standard deviation of the mean. Values were averaged for the entire recording period and dichotomized at the lowest tertile for both variables. Functional outcome was assessed using the modified Rankin scale (mRS) at 90 days and dichotomized into good (mRS 0-2) and poor outcome (mRS 3-6). Results: We included 195 patients (mean age 70 + 16, 45% female, mean NIHSS 14, mean monitoring time 15 + 7 hours). After adjusting for age, NIHSS, ASPECTS, and TICI score, patients with low BP variability and intact autoregulation were significantly more likely to achieve a good outcome than those with high BP variability and impaired autoregulation (OR 3.7, 95% CI 1.2-12.1, p=0.028, Figure 1A). We found an interaction between BP variability and autoregulation (p=0.067). Patients with high BP variability showed a gradual decrease in the probability of a good outcome with worsening autoregulation. However, for patients with low BPV, autoregulation had minimal impact. (Figure 1B). No significant correlation was seen between autoregulatory function and BP variability (r=0.07, p=0.33). Conclusions: For LVO stroke patients with high BP variability after EVT, worse 90-day functional outcome may be exacerbated by impaired autoregulation. These results suggest that autoregulatory status should be considered in the management of BP after EVT to identify high-risk patients and develop individualized treatment strategies.

Effects of REM Sleep and systolic blood pressure variability on five-year cardiovascular disease risk

Effects of REM Sleep and systolic blood pressure variability on five-year cardiovascular disease risk

Abstract WP282: Association of Very Short Interval Blood Pressure Variability With Stroke

Background: While blood pressure variability (BPV) is associated with poor cardiovascular outcomes, the relationship between BPV obtained in a very short interval and stroke is unknown. We aim to examine the association between very short interval BPV and a history of stroke. Hypothesis: Higher BPV is associated with the likelihood of having a stroke. Methods: A cross-sectional study using 2017-2020 NHANES included 3 consecutive BP measurements taken 60 seconds apart. The average real variability (ARV) of systolic and diastolic BP (AVR-SBP and AVR-DBP) was assessed as an average of absolute difference in consecutive BP. The association of AVR-SBP and AVR-DBP and the history of stroke was examined by multiple logistic regression. Results: Of 9,693 adult participants, mean±SD age was 50±19 years and 51% were female. Up to 5% (487 patients) had a history of stroke. Mean of the three average SBP and DBP were 120±20 and 72±12 mmHg, respectively. Median (IQR) of ARV-SBP was 3.5 (2, 6) mmHg and of ARV-DBP was 2.4 (1.5, 4) mmHg. Patients with stroke had significantly higher SBP and ARV-SBP, but not DBP and ARV-DBP compared to non-stroke patients (mean difference (95%CI) of SBP 11 (9, 13); ARV-SBP 0.7, (0.4, 1.1); DBP 0.7 (-0.5, 1.9); ARV-DBP 0.1 (-0.2, 0.4)). For every one mmHg increase in ARV-SBP, there was a 4.6% significantly greater odds of stroke (OR (95%CI) 1.05 (1.02, 1.07)), while there were 1.6% greater odds of stroke for every one mmHg increase in ARV-DBP but no statistical significance (OR 1.02 (0.98, 1.05)). After adjusting for age, gender, race, ethnicity, and BMI, the odds of stroke were 2.8% significantly higher for every one mmHg increase in ARV-SBP (OR 1.03 (1.00, 1.05)) and the ARV - stroke association remained non-significant. ARV-SBP was only associated with stroke in patients who were diagnosed with a stroke at an age &lt; 50 years old, while ARV-DBP was not associated with stroke regardless of the age when the stroke was diagnosed. Conclusions: ARV-SBP in a very short interval is associated with prior history of stroke in younger than 50 years old. Impaired cerebral vasculatures may affect autoregulation in younger patients with stroke, which possibly manifests as BPV. Longitudinal cohort studies to determine the association between BPV and stroke are required.

Tilt-evoked, breathing-driven blood pressure oscillations: Independence from baroreflex-sympathoneural function

PurposeOrthostasis increases the variability of continuously recorded blood pressure (BP). Low-frequency (LF) BP oscillations (Mayer waves) in this setting are related to the vascular-sympathetic baroreflex. Mechanisms of increased high-frequency (HF) BP oscillations at the periodicity of respiration during orthostasis have received less research attention. A previously reported patient with post-neurosurgical orthostatic hypotension (OH) and vascular-sympathetic baroreflex failure had large tilt-evoked, breathing-driven BP oscillations, suggesting that such oscillations can occur independently of vascular-sympathetic baroreflex modulation. In the present study we assessed effects of orthostasis on BP variability in the frequency domain in patient cohorts with or without OH.MethodsPower spectral analysis of systolic BP variability was conducted on recordings from 73 research participants, 42 with neurogenic OH [13 pure autonomic failure, 14 Parkinson’s disease (PD) with OH, 12 parkinsonian multiple system atrophy, and 3 status post-brainstem neurosurgery] and 31 without OH (control group of 16 healthy volunteers and 15 patients with PD lacking OH), before, during, and after 5′ of head-up tilt at 90 degrees from horizontal. The data were log transformed for statistical testing.ResultsAcross all subjects, head-up tilting increased HF power of systolic BP variability (p = 0.001), without a difference between the neurogenic OH and control groups. LF power during orthostasis was higher in the control than in the OH groups (p = 0.009).ConclusionsThe results of this observational cohort study confirm those based on our case report and lead us to propose that even in the setting of vascular-sympathetic baroreflex failure orthostasis increases HF power of BP variability.

Abstract TP190: Higher Pre-Hospital Blood Pressure is Associated With Lower Mismatch Volume and Poorer Collateral Status in Patients With Acute Ischemic Stroke Due to Large Vessel Occlusions

Introduction: Immediately after AIS onset, blood pressure variability (BPV) arises as the result of a complex interplay between brain and systemic physiological hemodynamic responses. In this study, we examined the effect of BPV on early infarct growth in patients with large vessel occlusions (LVO) during their prehospital transfer. Methods: We included consecutive patients with AIS-LVO from 2 large comprehensive stroke centers. We collected the BP values from emergency medical services arrival to hospital admission. Patients with &lt;3 BP recordings were excluded. BPV was assessed using the standard deviation (SD) of the systolic (SBPv), diastolic (DBPv), and mean BP (MBPv). Initial infarct volume (IIV) was defined as rCBF &lt;30%, penumbra area as time to maximum concentration (Tmax) &gt;6s, and mismatch volume as the difference between these two volumes (Tmax 6 - rCBF&lt;30%). Collateral status was evaluated using the hypoperfusion intensity ratio (HIR), defined as the Tmax&gt;10s/Tmax&gt;6s ratio. We used linear regression to investigate associations between these variables, using log-transformation to achieve normality, and final exponentiation for a better interpretability of the results. Results: We included 171 patients, mean age was 70.9± 13.7, 51.5% female, 88.3% white, median NIHSS was 15. Mean BP: SBP=12.37 + 6.8, DBP=10.2 + 7.1, and MBP=8.9 + 5.9. CTP values: rCBF &gt;30% (5 [IQR 0.001 - 22]), Tmax &gt;6s (103 [60.5 - 158.5]), and HIR (0.38 [0.17 - 0.54]). Higher SBP variability was significantly associated with lower mismatch volumes. Furthermore, higher SBP tertiles were associated with worse collaterals (high HIR) (Figure) . Conclusion: Pre-hospital BPV is associated with lower mismatch volume, likely mediated by the effect of BP on collateral status. Our findings are consistent with previous studies; the association between higher pre-treatment blood pressure and poorer collaterals might be due to an imbalance in the need of increasing perfusion to the ischemic tissue.

Legacy benefits of blood pressure treatment on cardiovascular events are primarily mediated by improved blood pressure variability: the ASCOT trial.

Visit-to-visit systolic blood pressure variability (BPV) is an important predictor of cardiovascular (CV) outcomes. The long-term effect of a period of blood pressure (BP) control, but with differential BPV, is uncertain. Morbidity and mortality follow-up of UK participants in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure-Lowering Arm has been extended for up to 21 years to determine the CV impact of mean systolic blood pressure (SBP) control and BPV during the trial, and amongst those allocated to amlodipine- and atenolol-based treatment. Eight thousand five hundred and eighty hypertensive participants (4305 assigned to amlodipine ± perindopril-based and 4275 to atenolol ± diuretic-based treatment during the in-trial period (median 5.5 years) were followed for up to 21 years (median 17.4 years), using linked hospital and mortality records. A subgroup of participants (n = 2156) was followed up 6 years after the trial closure with a self-administered questionnaire and a clinic visit. In-trial mean SBP and standard deviation of visit-to-visit SBP as a measure of BPV, were measured using >100 000 BP measurements. Cox proportional hazard models were used to estimate the risk [hazard ratios (HRs)], associated with (i) mean with SBP and BPV during the in-trial period, for the CV endpoints occurring after the end of the trial and (ii) randomly assigned treatment to events following randomization, for the first occurrence of pre-specified CV outcomes. Using BP data from the in-trial period, in the post-trial period, although mean SBP was a predictor of CV outcomes {HR per 10 mmHg, 1.14 [95% confidence interval (CI) 1.10-1.17], P < .001}, systolic BPV independent of mean SBP was a strong predictor of CV events [HR per 5 mmHg 1.22 (95% CI 1.18-1.26), P < .001] and predicted events even in participants with well-controlled BP. During 21-year follow-up, those on amlodipine-based compared with atenolol-based in-trial treatment had significantly reduced risk of stroke [HR 0.82 (95% CI 0.72-0.93), P = .003], total CV events [HR 0.93 (95% CI 0.88-0.98), P = .008], total coronary events [HR 0.92 (95% CI 0.86-0.99), P = .024], and atrial fibrillation [HR 0.91 (95% CI 0.83-0.99), P = .030], with weaker evidence of a difference in CV mortality [HR 0.91 (95% CI 0.82-1.01), P = .073]. There was no significant difference in the incidence of non-fatal myocardial infarction and fatal coronary heart disease, heart failure, and all-cause mortality. Systolic BPV is a strong predictor of CV outcome, even in those with controlled SBP. The long-term benefits of amlodipine-based treatment compared with atenolol-based treatment in reducing CV events appear to be primarily mediated by an effect on systolic BPV during the trial period.