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

Chen, Yajing; Ma, Yuxia; Qin, Jiangxia; Wei, Xiaoqin; Yang, Yiyi; Yuan, Yue; Yan, Fanghong; Huo, Xiaoning; Han, Lin

doi:10.1007/s00415-023-12054-w

Cited by 5 publications

(2 citation statements)

References 70 publications

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“…Similarly, in patients undergoing endovascular therapy, higher blood pressure variability within the first 24 h has been associated with a poor prognosis at 90 days, with systolic blood pressure variability being particularly influential [ 36 ]. Even in patients with AIS who do not receive intravenous thrombolysis or endovascular therapy, higher systolic and diastolic blood pressure variability has been linked to an increased risk of poor prognosis [ 37 ]. These findings underscore the importance of recognizing blood pressure variability as a clinically relevant risk factor for prognosis in patients with AIS.…”

Section: Discussionmentioning

confidence: 99%

Association between oral microbial nitrate metabolism and poor prognosis in acute ischemic stroke patients with a history of hypertension

Ren,

Liang,

et al. 2024

Journal of Oral Microbiology

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Background Oral microbes mediate the production of nitric oxide (NO) through the denitrification pathway. This study aimed to investigate the association between oral microbial nitrate metabolism and prognosis in acute ischemic stroke (AIS) patients. Methods This prospective, observational, single-center cohort study included 124 AIS patients admitted within 24 hours of symptom onset, with 24-hour ambulatory blood pressure data. Oral swabs were collected within 24 hours. Hypertensive AIS patients were stratified by the coefficient of variation (CV) of 24-hour systolic blood pressure. Microbial composition was analyzed using LEfSe and PICRUSt2 for bacterial and functional pathway identification. Results Significant differences in oral microbiota composition were observed between hypertensive AIS patients with varying CVs. Lower CV groups showed enrichment of nitrate-reducing bacteria and “Denitrification, nitrate => nitrogen” pathways. The TAX score of oral nitrate-reducing bacteria, derived from LASSO modeling, independently correlated with 90-day modified Rankin Scale scores, serving as an independent risk factor for poor prognosis. Mediation analyses suggested indirect that the TAX score not only directly influences outcomes but also indirectly affects them by modulating 24-hour systolic blood pressure CV. Conclusions AIS patients with comorbid hypertension and higher systolic blood pressure CV exhibited reduced oral nitrate-reducing bacteria, potentially worsening outcomes.

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Section: Discussionmentioning

confidence: 99%

Association between oral microbial nitrate metabolism and poor prognosis in acute ischemic stroke patients with a history of hypertension

Ren,

Liang,

et al. 2024

Journal of Oral Microbiology

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“…According to a systematic review and meta-analysis of 18 observational studies, systolic BPV was also significantly associated with poor functional outcomes and dependency at 3 months [11]. A more recent, updated systematic review and meta-analysis, that included 34 observational studies, confirmed that higher BPV is associated with worse functional outcomes, mortality, and early neurological deterioration among acute ischaemic stroke patients [38]. However, whether there is a direct causal relationship between BPV and adverse outcomes post-stroke is still debatable [39,40].…”

Section: Blood Pressure Variability Among Patients With Acute Ischaem...mentioning

confidence: 99%

Blood Pressure Variability in Acute Stroke: A Narrative Review

Zompola,

Palaiodimou,

Voumvourakis

et al. 2024

JCM

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The management of blood pressure variability (BPV) in acute stroke presents a complex challenge with profound implications for patient outcomes. This narrative review examines the role of BPV across various stages of acute stroke care, highlighting its impact on treatment strategies and prognostic considerations. In the prehospital setting, while guidelines lack specific recommendations for BP management, emerging evidence suggests a potential link between BPV and outcomes. Among ischaemic stroke patients who are ineligible for reperfusion therapies, BPV independently influences functional outcomes, emphasising the need for individualised approaches to BP control. During intravenous thrombolysis and endovascular therapy, the intricate interplay between BP levels, recanalisation status, and BPV is evident. Striking a balance between aggressive BP lowering and avoiding hypoperfusion-related complications is essential. Intracerebral haemorrhage management is further complicated by BPV, which emerges as a predictor of mortality and disability, necessitating nuanced BP management strategies. Finally, among patients with acute subarachnoid haemorrhage, increased BPV may be correlated with a rebleeding risk and worse outcomes, emphasizing the need for BPV monitoring in this population. Integration of BPV assessment into clinical practice and research protocols is crucial for refining treatment strategies that are tailored to individual patient needs. Future studies should explore novel interventions targeting BPV modulation to optimise stroke care outcomes.

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Effects of long-term almond consumption on markers for vascular function and cardiometabolic risk in men and women with prediabetes: results of a randomized, controlled cross-over trial

Chavez-Alfaro,

Mensink,

Gravesteijn

et al. 2024

Eur J Nutr

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

Cited by 5 publications

References 70 publications

Association between oral microbial nitrate metabolism and poor prognosis in acute ischemic stroke patients with a history of hypertension

Association between oral microbial nitrate metabolism and poor prognosis in acute ischemic stroke patients with a history of hypertension

Blood Pressure Variability in Acute Stroke: A Narrative Review

Effects of long-term almond consumption on markers for vascular function and cardiometabolic risk in men and women with prediabetes: results of a randomized, controlled cross-over trial

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