Day-by-Day Blood Pressure Variability Is Associated With Neurological Functional Outcome After Acute Ischemic Stroke

Yang, Changqiang; Song, Yue; Gong, Shenzhen; Ye, Runyu; Zhang, Zhipeng; Chen, Xiaoping

doi:10.3389/fneur.2020.566825

Cited by 9 publications

(10 citation statements)

References 29 publications

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“…Studies on the short-term influence of DBP variability on the neurological outcomes of patients with AIS are inconsistent. Our results are in line with studies that uncovered that DBP variability contributes to the functional deterioration of patients with AIS [20][21][22][23], although the majority of the literature exhibit that SBP variability is a better predictor of worse neurological outcomes [11,14,15,24,25]. While a high DBP variability may impact the ventricular end-diastolic volume and the cerebral perfusion in patients with impaired cerebral blood flow autoregulation, the J-curve relationship between DBP and cardiovascular events may produce a confounding effect on stroke outcomes [26].…”

Section: Discussionsupporting

confidence: 89%

“…In fact, many systematic reviews and meta-analyses have associated high blood pressure levels in patients with AIS with dependency, deterioration, and death [7,8]. Regardless of the absolute systolic (SBP) and diastolic (DBP) blood pressure levels, blood pressure variability (BPV) is an independent predictor of stroke outcome [9][10][11][12][13][14][15]. This association is greater with SBP variability, while the prognostic significance of DBP variability remains uncertain [15].…”

Section: Systolic Blood Pressure Variability Within 120 Hours Of Admi...mentioning

confidence: 99%

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Systolic blood pressure variability within 120 hours of admission predicts the functional outcomes at discharge of patients with acute ischemic stroke

et al. 2022

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Background: Blood pressure variability (BPV) is a predictor of short- and long-term disability in patients with acute ischemic stroke (AIS). Its effect on more immediate functional outcomes has been seldom studied, and the results are inconsistent. We aimed to determine the role of BPV during the first 5 days of hospitalization in functional status at the time of discharge of patients with AIS.Methods: We enrolled 134 patients diagnosed with AIS and BPV using standard deviation and coefficient of variation (CV %). These were associated with the dichotomized modified Rankin Scale at discharge using logistic regression. Results: Patients with unfavorable outcomes were significantly older (P=0.014), had a lower body mass index (P=0.001), were less likely to present with dyslipidemia (P=0.001), had lower serum triglyceride levels (P=0.012), had a longer hospitalization period (P<0.001), and had a higher mean National Institutes of Health Stroke Scale score at admission (P<0.001). After adjusting for multiple confounders, the CV % of systolic blood pressure (SBP) in the first 120 hours after admission had a significant effect on functional disability at discharge. Conclusion: Variability in SBP in the first 5 days of hospitalization had a deleterious effect on the functional outcomes at discharge of patients with AIS. The role of diabolic blood pressure variability seems to be significant only in the first 24 hours of admission; however, further research is required.

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Section: Discussionsupporting

confidence: 89%

Section: Systolic Blood Pressure Variability Within 120 Hours Of Admi...mentioning

confidence: 99%

Systolic blood pressure variability within 120 hours of admission predicts the functional outcomes at discharge of patients with acute ischemic stroke

et al. 2022

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“…The conclusion of the research that deals with BPV 72 h after stroke onset and functional outcome ( 21 , 22 ) was consistent with our study but mainly focused on the subacute stage of AIS. Two previous studies concerning daily BPV validated and improved these findings ( 24 , 25 ). Wang et al ( 24 ) attempted to explore the association between mid-term BPV within 7 days of onset and prognosis in patients with AIS, and they disclosed consistent observations.…”

Section: Discussionsupporting

confidence: 55%

“…Two previous studies concerning daily BPV validated and improved these findings ( 24 , 25 ). Wang et al ( 24 ) attempted to explore the association between mid-term BPV within 7 days of onset and prognosis in patients with AIS, and they disclosed consistent observations. In their study, they aimed to determine a possible connection between the two.…”

Section: Discussionsupporting

confidence: 55%

Daily blood pressure variability in relation to neurological functional outcomes after acute ischemic stroke

Zhu

Zheng

et al. 2023

Front. Neurol.

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BackgroundPrior research has shown inconclusive findings regarding the relationship between blood pressure variability (BPV) in acute ischemic stroke (AIS) and functional outcomes. Most research has examined the connection between short-term BPV during the early 24–72 h after the occurrence of ischemic stroke and functional prognosis. We sought to determine the relationship between daily BPV at 7 days of commencement and functional outcomes during the 3 months following AIS.MethodsAltogether, 633 patients with AIS admitted within 72 h of commencement were enrolled. AIS was defined as the time from the onset of symptoms to 7 days. Throughout this period, blood pressure (BP) was recorded twice daily (casual BP cuffs). The daily BPV, with standard deviation (SD) and coefficient of variation (CV), was calculated and matched to the functional results. The adverse outcome was characterized as a modified Rankin scale (mRS)≥3, which comprised the recurrence of stroke, clinical intracranial bleeding, and death.ResultsIn total, 633 participants were included, and the incidence of adverse outcomes was 14.06% (89/633). There was a significant positive correlation between daily BPV and adverse outcomes but not between mean BP and risk. Smooth curve fitting revealed a U-shaped connection between the mean BP and adverse clinical outcomes. Multivariable logistic regression analysis showed an independent correlation between daily BPV and an adverse outcome in the top vs. bottom quartile of systolic BPV (odds ratio [OR] = 2.4, 95% confidence interval [CI]: 1.17–4.96, P = 0.018 for SD; OR = 2.4, 95% CI: 1.17–4.93, P = 0.017 for CV) during a 3-month follow-up period. Identical results have been reported for diastolic BPV.ConclusionIrrespective of BP level, elevated daily systolic BPV and diastolic BPV in AIS were associated with an increased risk of adverse outcomes within 3 months. We also discovered a U-shaped association between the mean BP and adverse clinical outcomes. These findings suggested that BPV should be a risk factor for adverse outcomes after ischemic stroke, which provided new insight into BP management strategy.

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“…However, not all patients are eligible for intravenous thrombolysis due to the extended time window or the lack of access to advanced imaging modalities. Although many factors, including the presence of comorbidities, blood homocysteine concentration, 2 blood pressure (BP) variability, 3 and the National Institutes of Health Stroke Scale (NIHSS) score affect long-term outcomes after AIS, there is still a need for other markers that could help predict long-term outcomes among patients with AIS.…”

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confidence: 99%

Association Between Cerebral Autoregulation and Long-Term Outcome in Patients With Acute Ischemic Stroke

et al. 2022

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Background: Dynamic cerebral autoregulation (CA) is known to be impaired in patients with acute ischemic stroke (AIS), but whether or not dynamic CA can predict long-term outcomes is unclear.Materials and Methods: This prospective study included 103 patients with AIS between September 2017 and April 2019. We measured the middle cerebral artery blood flow velocity and blood pressure within 7 days of AIS onset using a transcranial Doppler and Finometer, respectively. We conducted transfer function analysis to calculate dynamic CA indices (phase and gain), with lower phase and higher gain parameters reflecting less efficient CA. We followed up all patients after 3 and 12 months. Patients with 12-month modified Rankin Scale scores of < 2 and ≥ 2 were defined as having favorable and unfavorable outcomes, respectively. We then analyzed the predictors of unfavorable outcomes after 3 and 12 months using logistic regression. Results:The ipsilesional phase parameter was significantly lower in patients with unfavorable outcomes than in those with favorable outcomes. Multiple logistic regression analysis revealed that the ipsilesional phase parameter and the National Institutes of Health Stroke Scale score were nonmodifiable predictors of short-term and long-term outcomes. Moreover, in receiver operating characteristic analysis, the area under the curve of the ipsilesional phase parameter was 0.646 (95% confidence interval: 0.513-0.779, P = 0.044). Notably, the optimal cut-off value was 20.33 degrees (sensitivity: 63%, specificity: 70%). Conclusion:Dynamic CA is an independent predictor of outcomes at 3 and 12 months in patients with AIS.

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Day-by-Day Blood Pressure Variability Is Associated With Neurological Functional Outcome After Acute Ischemic Stroke

Cited by 9 publications

References 29 publications

Systolic blood pressure variability within 120 hours of admission predicts the functional outcomes at discharge of patients with acute ischemic stroke

Systolic blood pressure variability within 120 hours of admission predicts the functional outcomes at discharge of patients with acute ischemic stroke

Daily blood pressure variability in relation to neurological functional outcomes after acute ischemic stroke

Association Between Cerebral Autoregulation and Long-Term Outcome in Patients With Acute Ischemic Stroke

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