Prognostic Significance of Short-Term Blood Pressure Variability in Acute Stroke

Abstract

Background and Purpose— Blood pressure variability (BPV) may be an important prognostic factor acutely after stroke. This review investigated the existing evidence for the effect of BPV on outcome after stroke, also considering BPV measurement techniques and definitions. Methods— A literature search was performed according to a prespecified study protocol. Two reviewers independently assessed study eligibility and quality. Where appropriate, meta-analyses were performed to assess the effect of BPV on poor functional outcome. Results— Eighteen studies from 1359 identified citations were included. Seven studies were included in a meta-analysis for the effect of BPV on functional outcome (death or disability). Systolic BPV was significantly associated with poor functional outcome: pooled odds ratio per 10-mm Hg increment, 1.2; confidence interval (1.1–1.3). A descriptive review of included studies also supports these findings, and in addition, it suggests that systolic BPV may be associated with increased risk of intracranial hemorrhage in those treated with thrombolytic therapy. Conclusions— This systematic review and meta-analysis suggest that greater systolic BPV, measured early from ischemic stroke or intracerebral hemorrhage onset, is associated with poor longer-term functional outcome. Future prospective studies should investigate how best to measure and define BPV in acute stroke, as well as to determine its prognostic significance.

Trajectory Groups of 24-Hour Systolic Blood Pressure After Acute Ischemic Stroke and Recurrent Vascular Events

“…A recently published report suggested that increased variability of SBP in acute stressful conditions was modestly associated with functional outcomes, beyond conventional measures of SBP. 16 Short-term BP variations usually reflect the influence of central and reflex autonomic modulation, elastic properties of arteries, and the effects of humoral, rheological, and emotional factors of diverse nature and duration. 17 For patients with acute stroke, BP change and trajectory patterns after ischemic stroke would be consequences of short-term Figure. Trajectory groups of 24-h systolic blood pressure (SBP) after arrival; estimated blood pressures and 95% confidence intervals (CIs).…”

Increased blood pressure variability after endovascular thrombectomy for acute stroke is associated with worse clinical outcome

“…This impairment in autoregulation may leave the ischemic tissue susceptible to fluctuations in blood pressure. While mean blood pressure has fallen out of favor as being a main contributor to stroke outcome, blood pressure variability (BPV) after stroke has become an area of increasing interest 11. A recent systematic review summarized the available data and concluded that increased BPV after stroke is associated with higher rates of death and disability 11.…”

Reciprocal Interaction of 24-Hour Blood Pressure Variability and Systolic Blood Pressure on Outcome in Stroke Thrombolysis

“…[14][15][16] The randomized ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study, BP arm) investigating superior efficacy and lower risk of any intracerebral hemorrhage of early intensive lowering of BP (systolic target 130-140 mm Hg) versus BP control as recommended in guidelines (systolic target <180 mm Hg) is ongoing, and results are anticipated in 2018. 17 For several years, stroke neurologists have focused on not only standard BP parameters but also BP variability (BPV, for review Manning et al 18 ). For the short-term BPV, higher BPV was shown to increase the rates of SICH, death, and poor outcome after stroke.…”

“…The authors may also point toward a better understanding of variability as BP characteristic (see Manning Stroke 2015 for review 18 ). In observational studies, where BP management is not actively monitored, it is unclear what we exactly measure when we measure BPV.…”