Blood pressure variability and stroke outcome in patients with internal carotid artery occlusion

Buratti, Laura; Cagnetti, Claudia; Balucani, Clotilde; Viticchi, Giovanna; Falsetti, Lorenzo; Luzzi, Simona; Lattanzi, Simona; Provinciali, Leandro; Silvestrini, Mauro

doi:10.1016/j.jns.2014.02.007

Cited by 75 publications

(72 citation statements)

References 41 publications

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“…The detrimental effect of increased BPV was also seen in patients with PVO, which has been reported in previous studies,12 31 and in patients with good collaterals, which is a novel finding. Patients with PVO are more likely to have a large lesion core and hypoperfused volume, which could account for the differential effect.…”

Section: Discussionsupporting

confidence: 79%

Determinants of the impact of blood pressure variability on neurological outcome after acute ischaemic stroke

et al. 2017

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IntroductionIncreased blood pressure variability (BPV) is detrimental after acute ischaemic stroke, but the interaction between BPV and neuroimaging factors that directly influence stroke outcome has not been explored.MethodsWe retrospectively reviewed inpatients from 2007 to 2014 with acute anterior circulation ischaemic stroke, CT perfusion and angiography at hospital admission, and a modified Rankin Scale (mRS) 30–365 days after stroke onset. BPV indices included SD, coefficient of variation and successive variation of the systolic blood pressure between 0 and 120 hours after admission. Ordinal logistic regression models were fitted to mRS with predictor variables of BPV indices. Models were further stratified by CT perfusion volumetric measurements, proximal vessel occlusion and collateral score.Results110 patients met the inclusion criteria. The likelihood of a 1-point rise in the mRS increased with every 10 mm Hg increase in BPV (OR for the 3 BPV indices ranged from 2.27 to 5.54), which was more pronounced in patients with larger ischaemic core volumes (OR 8.37 to 18.0) and larger hypoperfused volumes (OR 6.02 to 15.4). This association also held true for patients with larger mismatch volume, proximal vessel occlusion and good collateral vessels.ConclusionsThese results indicate that increased BPV is associated with worse neurological outcome after stroke, particularly in patients with a large lesion core volume, concurrent viable ischaemic penumbra, proximal vessel occlusion and good collaterals. This subset of patients, who are often not candidates for or fail acute stroke therapies such as intravenous tissue plasminogen activator or endovascular thrombectomy, may benefit from interventions aimed at reducing BPV.

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Section: Discussionsupporting

confidence: 79%

Determinants of the impact of blood pressure variability on neurological outcome after acute ischaemic stroke

et al. 2017

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“…An association between exaggerated BPV and cognitive dysfunction has been reported, but whether exaggerated BPV may be causally related to cognitive dysfunction or simply a result of cognitive dysfunction remains unclear. Some studies have suggested that exaggerated BPV may contribute to cognitive dysfunction, since it has been demonstrated to have detrimental effects on the cerebral perfusion and cerebral hemodynamic as well as alter the neurovascular coupling . On the other hand, there is also evidence that the autonomic dysregulation or neurodegeneration, both of which cause cognitive dysfunction, may lead to exaggerated BPV .…”

Section: Discussionmentioning

confidence: 99%

Exaggerated blood pressure variability is associated with memory impairment in very elderly patients

Fujiwara

Hoshide

Kanegae

et al. 2018

J of Clinical Hypertension

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We investigated the association between working memory (WM) impairment and blood pressure variability (BPV) in very elderly patients. Japanese outpatients ≥80 years who engaged in normal activities of daily living were the study cohort. WM function was evaluated by a simple visual WM test consisting of 3 figures. We considered the number of figures recalled by the patient his/her test score. We defined the patients with a score of 0 or 1 as those with WM impairment and those with scores of 2 or 3 as those without. To investigate the relative risk of WM impairment, we evaluated each patient's 24 hour ambulatory systolic blood pressure (SBP) and its weighted standard deviation (SD ), office SBP, and the visit-to-visit SD during the 1 year period from the patient's enrollment. A total of 66 patients (mean 84 ± 3.6 years) showed WM impairment, and 431 patients (mean 83 ± 3.1 years) showed no WM impairment. There were no significant differences in 24 hour ambulatory SBP or office SBP between these two groups. However, the WM impairment patients showed significantly higher weighted SD and visit-to-visit SD values compared to the no-impairment group even after adjusting for age. Among these ≥80-year-old patients, those with the highest quartile of both weighted SD (≥21.4 mm Hg) and visit-to-visit SD (≥14.5 mm Hg) showed the highest relative risk (odds ratio 3.52, 95% confidence interval 1.42-8.72) for WM impairment. Exaggerated blood pressure variability parameters were significantly associated with working memory impairment in very elderly individuals.

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“…The artery remodeling can act as an upstream factor of the cerebral blood flow imbalance and favor the β‐amyloid deposition and reactive gliosis . Furthermore, exaggerated BPV can have detrimental effects on the cerebral blood flow and hemodynamics . Marked oscillations in the arterial BP can favor inconsistent perfusion and repeated episodes of tissue hypoxia‐ischemia that are able to promote the microglia activation and brain amyloidogenesis.…”

Section: Blood Pressure Variability: a Novel Vascular Risk Factormentioning

confidence: 99%

Blood pressure variability and neurocognitive functioning

Lattanzi

Vernieri

Silvestrini

2018

J of Clinical Hypertension

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Cognitive impairment is a worldwide public health and social care concern. It has striking consequences to patients, caregivers, and the healthcare system, and is an exponentially raising disease burden due to the aging population. Dementia affects approximately 1.5% of people aged 65-70 years and the prevalence increases up to 25% among people aged 85 and over. Accordingly, the high short-and long-term BPVs can be reasonably

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Blood pressure variability and stroke outcome in patients with internal carotid artery occlusion

Cited by 75 publications

References 41 publications

Determinants of the impact of blood pressure variability on neurological outcome after acute ischaemic stroke

Determinants of the impact of blood pressure variability on neurological outcome after acute ischaemic stroke

Exaggerated blood pressure variability is associated with memory impairment in very elderly patients

Blood pressure variability and neurocognitive functioning

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