Prognostic Significance of Blood Pressure Variability on Beat-to-Beat Monitoring After Transient Ischemic Attack and Stroke

Webb, Alastair; Mazzucco, Sara; Li, Linxin; Rothwell, Peter M.

doi:10.1161/strokeaha.117.019107

Cited by 83 publications

(98 citation statements)

References 21 publications

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“…Evident markers of the negative prognosis are such simple indicators as orthostatic hypertension and increased variability of BP, the detection of which should alarm both the doctor and patient. Similar data describing the increase of short-term variability were also reported [14]. In this case, vasomotor reactivity may be one of the reasons for insufficient control of BP, thus requiring the use of individual approaches in the selection of therapy and disease control [15].…”

Section: Discussionsupporting

confidence: 76%

The Autonomic Regulation of Circulation and Adverse Events in Hypertensive Patients during Follow-Up Study

Mamontov

Козленок

Kamshilin

et al. 2019

Cardiology Research and Practice

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Purpose. Comprehensive study of autonomic regulation assessed during follow-up could provide new detailed information about the risks stratification for hypertensive patients. Therefore, we investigated the associations of these indices with death, stroke, and revascularization during the follow-up observation of 55 patients. Methods. All patients were with target organ damage, and 27 of them had associated clinical conditions (ACC). Mean age of patients with and without ACC was 62.6 ± 4.2 and 51.9 ± 9.9 (mean ± SD) years, respectively. Follow-up was from 66 to 95 months. At entry, autonomic regulation was assessed by the tilt test, Valsalva maneuver, hand-grip test, and cold-stress vasoconstriction. Hemodynamic parameters were measured by continuous blood pressure monitoring, occlusion plethysmography, and electrocardiography. Re-examination of patients was carried out by questioning and physical and laboratory examination. Results. We found that fatal outcomes were associated with a lower Valsalva index (1.34 ± 0.16 vs. 1.69 ± 0.37, P<0.05) and depressed cold vasoconstriction (0.20 ± 0.02 vs. 0.39 ± 0.16%, P<0.05) but with higher peripheral resistance (1.36 ± 0.19 vs. 0.89 ± 0.25, P<0.001) and respiratory-range blood pressure variability (BPV) (18.2 ± 14.2 vs. 6.2 ± 4.2 mmHg, P<0.001). Higher total-range BPV (103 ± 51 vs. 65 ± 45 mmHg, P<0.05) in patients who had a stroke was observed. Initial diastolic orthostatic hypertension (6.6 ± 10.8 vs. 0.4 ± 6.3 mmHg, P<0.05) and lower Valsalva index (1.36 ± 0.11 vs. 1.82 ± 0.37, P<0.05) in patients who suffered a new ACC were important findings as well. Conclusions. This study shows that such autonomic regulation indices as Valsalva index, blood pressure dynamics in the tilt test, cold-stress vasomotor reactivity, and BPV are important for prognosis of hypertension course.

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Section: Discussionsupporting

confidence: 76%

The Autonomic Regulation of Circulation and Adverse Events in Hypertensive Patients during Follow-Up Study

Mamontov

Козленок

Kamshilin

et al. 2019

Cardiology Research and Practice

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“…The results of our study were, to some extent, consistent with a previous report from the Oxford Vascular Study. 11 Moreover, we extended previous findings by assessment of BPV through day-to-day monitoring, enabling us to collect more reliable information. 12 Another important finding of this study is that DBPV was not only associated with stroke, but was strongly associated with cardiovascular events, even after adjusting for confounding variables.…”

Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 59%

Different contribution of SBP and DBP variability to vascular events in patients with stroke

et al. 2020

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BackgroundHigh blood pressure variability (BPV) is a novel risk factor for cardiovascular disease. However, the heterogeneity of systolic blood pressure variability (SBPV) and diastolic blood pressure variability (DBPV) for different vascular events remains unclear. This study aims to investigate whether SBPV or DBPV has different contribution to vascular events in patients with acute ischaemic stroke (IS) or transient ischaemic attack (TIA).MethodsData from the BOSS (blood pressure and clinical outcome in TIA or IS) study were examined for vascular events at 3-month and 1-year follow-up. BPV was defined as the SD and coefficient of variation (CV) of day-to-day measurements within 3 months after IS/TIA. Vascular events include cardiovascular events (myocardial infarction, unstable angina, cardiac death and congestive heart failure) and cerebrovascular events (ischaemic or haemorrhagic stroke). Logistic regression model was used to test the associations between BPV and vascular events.ResultsOf 2325 patients with IS or TIA, 103 (4.43 %) experienced a recurrent stroke and 64 (2.75 %) had cardiovascular events within 3 months. Day-to-day SBPV was only associated with stroke recurrence (BPVSD: OR, 1.72, 95% CI 1.09 to 2.71; BPVCV: 1.86, 95% CI 1.19 to 2.92), but not cardiovascular events (BPVSD: 1.67, 95% CI 0.94 to 2.94; BPVCV: 1.51, 95% CI 0.86 to 2.64). However, DBPV seems to be related to both stroke (BPVSD: 1.60, 95% CI 1.02 to 2.49; BPVCV: 1.53, 95% CI 0.99 to 2.37) and cardiovascular events (BPVSD: 2.48, 95% CI 1.37 to 4.48; BPVCV: 1.92, 95% CI 1.09 to 3.36). Similar results were found at 1 year.ConclusionsFor patients with IS/TIA, stroke recurrence was associated with both SBPV and DBPV; however, cardiovascular events seem to be only related to DBPV.

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“…As such, dichotomized thresholds for markedly elevated BPV are likely to have prognostic significant. Given an increased risk of recurrent events in the top quartile of BPV in this population, 11 with a Figure 2. Mean values of mean, maximum and rCV for systolic (SBP) and diastolic (DBP) blood pressure, stratified by sex and quintiles of age.…”

Section: Discussionmentioning

confidence: 99%

Age and sex distribution of beat-to-beat blood pressure variability after transient ischemic attack and minor stroke: A population-based study

Webb

Lawson

Mazzucco

et al. 2020

International Journal of Stroke

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Background Beat-to-beat blood pressure variability is associated with increased stroke risk but its importance at different ages is unclear. Aims To determine the age-sex distribution of blood pressure variability in patients with transient ischemic stroke or minor stroke. Methods In consecutive patients within six weeks of transient ischemic stroke or non-disabling stroke (Oxford Vascular Study), non-invasive blood pressure was measured beat-to-beat over five minutes (Finometer). The age-sex distribution of blood pressure variability (residual coefficient of variation) was determined for systolic blood pressure and diastolic blood pressure. The risk of top-decile blood pressure variability was estimated (logistic regression), unadjusted, and adjusted for age, sex, and cardiovascular risk factors. Results In 908 of 1013 patients, excluding 54 in atrial fibrillation and 51 with low quality recordings, residual coefficient of variation was positively skewed with a median systolic residual coefficient of variation of 4.2% (IQR 3.2–5.5) and diastolic residual coefficient of variation of 3.9% (3.0–5.5), with 90th centile thresholds of 7.2 and 7.3%. Median systolic residual coefficient of variation was higher in patients under 50 years (4.5 and 3.0–5.3) compared to 60–70 years (4.1 and 3.2–5.2), but rose to 4.5% (3.5–6.9) above 80 years, with an increasingly positive skew. The proportion of patients with markedly elevated blood pressure variability in the top-decile increased significantly per decade (OR 1.72, p < 0.001), after adjustment for sex and risk factors. Conclusions Median beat-to-beat blood pressure variability fell in midlife, reflecting loss of physiological, organized blood pressure variability. However, rates of markedly elevated blood pressure variability significantly increased with greater age, suggesting that blood pressure variability may be particularly important in older patients.

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Prognostic Significance of Blood Pressure Variability on Beat-to-Beat Monitoring After Transient Ischemic Attack and Stroke

Abstract: Supplemental Digital Content is available in the text.

Cited by 83 publications

References 21 publications

The Autonomic Regulation of Circulation and Adverse Events in Hypertensive Patients during Follow-Up Study

The Autonomic Regulation of Circulation and Adverse Events in Hypertensive Patients during Follow-Up Study

Different contribution of SBP and DBP variability to vascular events in patients with stroke

Age and sex distribution of beat-to-beat blood pressure variability after transient ischemic attack and minor stroke: A population-based study

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