Detrimental effect of increased blood pressure variability on clinical outcome in acute ischemic stroke treated with reperfusion therapy: a case control study

Abstract

Background Blood pressure variability (BPV) is related to clinical outcome in acute ischemic stroke (AIS) treated with reperfusion therapy, but still is not included in clinical practice. This study aims to associate BPV during the first week of AIS with the outcome at three months. Methods We included 236 AIS patients treated with reperfusion therapy, and then divided them into good outcome and poor outcome groups. BPV measurements, including standard deviation, coefficient of variation, average real variability (ARV), and range, were recorded at stages of 2 h, 24 h, and 7 days after reperfusion therapy, respectively. These measurements were compared between the two groups. Then, ROC curve analysis examined the ability of BPV measurements in differentiating good and poor outcome groups; logistic regression analysis detected variables associated with clinical outcome in all subjects. Results The good outcome group exhibited significantly less BPV at all stages relative to the poor outcome group. The BPV measurements exhibited the potential to differentiate the two groups by the ROC curve analysis, especially for those at the 24-h stage. Higher ARV of diastolic BP and higher range of systolic BP at the 24-h stage, together with greater disease severity at baseline, were associated with poor clinical outcome. Conclusions Greater BPV during the first week of AIS is associated with poor outcome for the patients treated with reperfusion therapy. The BPV measurements play an important role in modulating clinical outcome, and have the potential to be included in future AIS guidelines.

Blood Pressure Variability in Acute Stroke: A Narrative Review

“…However, according to an individual patient data meta-analysis that included 2460 patient data derived from five observational studies, systolic BPV within the first 24 h post-EVT, as expressed by the highest tertile of both standard deviation and coefficient of variation, was associated with higher mortality and disability at 3 months, independently of the mean systolic BP levels [86]. These results were further confirmed by several other cohort studies during the last few years (Table 2) [87][88][89][90], highlighting that the association of BPV with adverse clinical outcomes may even be intensified among patients receiving general anesthesia [91] or additional rescue treatment with balloon angioplasty or stenting [92]. One study-level meta-analysis that included 11 studies comprising more than 3500 patients, confirmed that higher systolic BPV was associated with lower odds of achieving good functional outcomes at 3 months [93].…”