Short-term blood pressure variability and long-term blood pressure variability: which one is a reliable predictor for recurrent stroke

Abstract

The relationship between blood pressure variability (BPV) and stroke recurrence is controversial. This study aimed to evaluate the predictive value of short-term and long-term BPV for stroke recurrence. The data from blood pressure and clinical outcome in TIA or ischemic stroke (BOSS) study included participants with acute ischemic stroke or transient ischemic attack (TIA) within 7 days after onset. Short-term BPV was measured by 24-h ambulatory BP measurement during hospitalisation. Long-term BPV, based on home blood pressure measurement, was measured by patients or their families from discharge to 90 days after qualifying events onset (twice daily). Variability for systolic blood pressure (SBP) was assessed as the s.d., coefficients of variance (CV). The clinical outcome was recurrent stroke within 1 year. Cox proportional hazards models were used to test the association of short-term BPV, long-term BPV and stroke recurrence. Among 1764 participants, the mean age was 62.45±10.99 years, and 32.1% were females, during 1-year follow-up, 106 (6.0%) participants experienced recurrent stroke. Indices of long-term BPV were significantly associated with stroke recurrence (s.d.: adjusted HR: 1.939, 95% CI: 1.122-3.351; CV: adjusted HR 1.955, 95% CI: 1.174-3.255), independent of mean SBP. However, all indices of short-term BPV (s.d., CV) were not associated with stroke recurrence (s.d.: adjusted HR: 1.245, 95% CI: 0.680-2.280; CV: adjusted HR: 1.142, 95% CI: 0.640-2.038). In conclusion, long-term variation of SBP is a better predictor than short-term variation of SBP for recurrent stroke after acute ischemic stroke or TIA.

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

“…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]. At the same time, strict control of blood pressure can improve the prognosis in patients with severe hypertension [16,17] that is likely to be sought in this group of patients.…”

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

“…First, short-term BPV was obtained by measuring blood pressure many times in a short period of time (24-72 h). These frequent measurements, especially using 24-h ambulatory blood pressure monitoring, with multiple inflation and deflation of the cuff, affected sleep quality of patients and changed the normal circadian rhythm of BP, which might affect the accuracy of blood pressure variability (23). Second, this short-term BPV could not completely rule out the effect of physiological variation of blood pressure and a higher cut-off value might be needed to reflect the pathological variability (23).…”

“…These frequent measurements, especially using 24-h ambulatory blood pressure monitoring, with multiple inflation and deflation of the cuff, affected sleep quality of patients and changed the normal circadian rhythm of BP, which might affect the accuracy of blood pressure variability (23). Second, this short-term BPV could not completely rule out the effect of physiological variation of blood pressure and a higher cut-off value might be needed to reflect the pathological variability (23). Therefore, we measured blood pressure at two relatively fixed points (respectively, in the morning during 8:00 a.m.−10:00 a.m., in the afternoon between 15:00 p.m. and 17:00 p.m.) for 7 consecutive days.…”

Retrospective cohort study of the relationship between systolic blood pressure variability and multiple sclerosis disability

“…Excessive SBP variability ( > 10 within-subject SD) has been associated with many of these outcomes independent of mean blood pressure and hypertension 8 11 12. Evidence suggests that visit-to-visit blood pressure variability may have stronger effects on cardiovascular outcomes than that of measures taken during a single visit or by 24 hours ambulatory monitoring devices 13–15. While various vascular comorbidities have been previously studied in the progression of MS, the relationship between SBP variability and MS progression has yet to be explored.…”