Interarm Blood Pressure Difference is Associated with Early Neurological Deterioration, Poor Short-Term Functional Outcome, and Mortality in Noncardioembolic Stroke Patients

Abstract

Background and PurposeInterarm differences in the systolic and diastolic blood pressures (IASBD and IADBD, respectively) are found in various populations, including stroke patients, but their significance for stroke outcomes has rarely been reported. We aimed to determine the associations of IASBD and IADBD with early neurological deterioration (END), functional outcome, and mortality.MethodsThis study included 1,008 consecutive noncardioembolic cerebral infarction patients who were admitted within 24 hours of onset and had automatic measurements of blood pressures in the bilateral arms. END was assessed within 72 hours of stroke onset according to predefined criteria. A poor functional outcome was defined as a score on the modified Rankin Scale ≥3 at 3 months after the index stroke. All-cause mortality was also investigated during a median follow-up of 24 months. The absolute difference of blood pressure measurements in both arms were used to define IASBD and IADBD.ResultsEND occurred in 15.3% (155/1,008) of the patients. A multivariate analysis including sex, age, and variables for which the p value was <0.1 in a univariate analysis revealed that IASBD ≥10 mm Hg was significantly associated with END [odds ratio (OR)=1.75, 95% CI=1.02–3.01]. IADBD ≥10 mm Hg was also related to END (OR=3.11, 95% CI=1.61–5.99). Moreover, having both IASBD ≥10 mm Hg and IADBD ≥10 mm Hg was related to a poor functional outcome (OR=2.67, 95% CI=1.36–5.35) and mortality (hazard ratio=7.67, 95% CI=3.76–12.83) even after adjusting for END.ConclusionsThis study suggests that an interarm blood pressure difference of ≥10 mm Hg could be a useful indicator for the risks of END, poor functional outcome, and mortality.

Acute in‐hospital blood pressure variability predicts early neurological deterioration in acute minor stroke or transient ischemic attack with steno‐occlusive arterial disease

“…Therefore, it is of great importance to identify factors associated with END in patients with acute minor stroke or TIA due to steno‐occlusive arterial disease. Based on the previous studies, several clinical and biological factors, such as older age, the initial neurological severity, diabetes mellitus, and blood pressure, might influent the development of END in patients with general ischemic stroke . To our best known, few studies focus on patients with acute minor stroke or TIA due to steno‐occlusive arterial disease.…”

“…Based on the previous studies, several clinical and biological factors, such as older age, the initial neurological severity, diabetes mellitus, and blood pressure, might influent the development of END in patients with general ischemic stroke. [8][9][10][11] To our best known, few studies focus on patients with acute minor stroke or TIA due to steno-occlusive arterial disease.…”

“…It is well known that BP is generally very dynamic and fluctuates considerably during the first several hours of acute ischemic stroke. 10,11 A failure of cerebral autoregulation occurs when there is a narrowing or blockage in the main arteries feeding blood to the brain. And at this moment, blood flow in ischemic brain regions is mainly determined by the systemic arterial pressure.…”

Association of interarm blood pressure difference with cardio‐cerebral vascular disease: A community‐based, cross‐sectional study

“…Chang et al found that IAD ≥10 mm Hg was associated with the presence and increased burden of cerebral small‐vessel diseases in noncardioembolic stroke patients. Another study suggested that an IAD of ≥10 mm Hg could be a useful indicator for the risks of early neurological deterioration, poor functional outcome, and mortality . Recently, increasing attention has been paid to better understanding the clinical outcome of sIAD, the most reported include subclinical atherosclerosis, left ventricular hypertrophy, aortic aneurysms, aortic dissection, and cardiovascular disease .…”

“…Another study suggested that an IAD of ≥10 mm Hg could be a useful indicator for the risks of early neurological deterioration, poor functional outcome, and mortality. 24 Recently, increasing attention has been paid to better understanding the clinical outcome of sIAD, the most reported include subclinical atherosclerosis, 25 left ventricular hypertrophy, 5 aortic aneurysms, 15 aortic dissection, and cardiovascular disease. 10 Inconsistent with above studies, three studies 4,5,26 compared cerebrovascular (stroke, cerebral atherosclerosis, and transient ischemic attack) outcomes among groups defined by sIAD of 10 mm Hg or more, and one study 26 compared outcomes at cutoff of 15 mm Hg or more, cumulative estimates were not statistically significant at either cutoff.…”