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Zhu Y, Wu M, Zheng Y, Wang X, Xiayang J, Zhang T, Wang S, Fang Z. Relationship of Day-by-Day Blood Pressure Variability and Admission Stroke Severity in Acute Ischemic Stroke. Neurologist 2024:00127893-990000000-00130. [PMID: 38444269 DOI: 10.1097/nrl.0000000000000556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
OBJECTIVES Research on the association between stroke severity and day-by-day blood pressure variability (BPV) in acute ischemic stroke (AIS) is rare as the majority focus on the blood pressure (BP) or the short-term BPV. Our study aims to explore the exact roles of daily BPV through the 7-day commencement on stroke severity in AIS. METHODS The study included 633 patients with AIS, defining AIS as the time from the beginning of symptom up to 7 days with recording BP twice a day as well as calculating the daily BPV, and then matching them to the stroke severity. The logistic regression models were used to evaluate associations between stroke severity and day-by-day BPV. We used the smooth curve fitting to identify whether there was a nonlinear association. In addition, the subgroup analyses were performed using the logistic regression. RESULTS According to the modified National Institutes of Health Stroke Scale score, 301 (47.5%) patients were allocated to the mild stroke group and 332 (52.5%) to the moderate-to-severe stroke group. In terms of stroke categories, we found no significant difference between BP at admission or mean BP. However, the moderate-to-severe stroke group exhibited higher daily BPV. The multiple logistic regression analysis indicated that day-by-day BPV was positively correlated to stroke severity [odds ratio (OR)=1.05, 95% CI:1.01-1.1, P=0.03 for SBP-SD; OR=1.08, 95% CI:1.01-1.15, P=0.03 for SBP-CV; OR=1.04, 95% CI:1.01-1.07, P=0.015 for SBP-SV). CONCLUSIONS High day-by-day BPV in AIS was associated with more severe stroke independent of BP levels.
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Affiliation(s)
- Yuan Zhu
- Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing
| | - Minghua Wu
- Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing
| | - Yawei Zheng
- Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing
| | - Xintong Wang
- Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing
| | - Jingyi Xiayang
- Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing
| | - Tianrui Zhang
- Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing
| | - Shana Wang
- Department of Clinical Medicine, Hangzhou Medical College, Hangzhou, China
| | - Zhuyuan Fang
- Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing
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Chen Y, Ma Y, Qin J, Wei X, Yang Y, Yuan Y, Yan F, Huo X, Han L. Blood pressure variability predicts poor outcomes in acute stroke patients without thrombolysis: a systematic review and meta-analysis. J Neurol 2024; 271:1160-1169. [PMID: 38036920 DOI: 10.1007/s00415-023-12054-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Stroke is a significant medical condition, and blood pressure stands out as the most prevalent treatable risk factor associated with it. Researches link blood pressure variability (BPV) with stroke; however, the specific relationship between with the outcomes of stroke patients remains unclear. As blood pressure variability and mean blood pressure are interrelated, it remains uncertain whether BPV adds additional information to understanding the outcome of acute stroke patients. OBJECTIVE To systematically review studies investigating the association between blood pressure variability and prognosis in acute stroke patients. METHODS Embase, PubMed, Web of Science, and the Cochrane Library were searched for English language full-text articles from the inception to 1 January 2023. Stroke patients aged ≥ 18 years were included in this analysis. Stroke types were not restricted. RESULTS This meta-analysis shows that higher systolic blood pressure variability is linked to a higher risk of poor outcome, including function disability, mortality, early neurological deterioration, and stroke recurrence, among acute stroke patients without thrombolysis. A higher diastolic blood pressure variability is linked with to a higher risk of mortality and functional disability. CONCLUSIONS This review reveals that blood pressure variability is a novel and clinically relevant risk factor for stroke patients' outcome. Future studies should investigate how best to measure and define BPV in acute stroke. Larger studies are warranted to provide more robust evidence in this area.
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Affiliation(s)
- Yajing Chen
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
| | - Yuxia Ma
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China.
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730030, Gansu Province, China.
| | - Jiangxia Qin
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
| | - Xiaoqin Wei
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
| | - Yiyi Yang
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
| | - Yue Yuan
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
| | - Fanghong Yan
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
| | - Xiaoning Huo
- The Third People's Hospital of Lanzhou, No.130 Jianlan New Village, Lanzhou, Gansu Province, China
| | - Lin Han
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China.
- Department of Nursing, Gansu Provincial Hospital, No. 204 Donggang West Road, Lanzhou, Gansu Province, China.
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Zhu Y, Wu M, Wang H, Zheng Y, Zhang S, Wang X, Wang S, Fang Z. Daily blood pressure variability in relation to neurological functional outcomes after acute ischemic stroke. Front Neurol 2023; 13:958166. [PMID: 36698896 PMCID: PMC9868909 DOI: 10.3389/fneur.2022.958166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/25/2022] [Indexed: 01/12/2023] Open
Abstract
Background Prior research has shown inconclusive findings regarding the relationship between blood pressure variability (BPV) in acute ischemic stroke (AIS) and functional outcomes. Most research has examined the connection between short-term BPV during the early 24-72 h after the occurrence of ischemic stroke and functional prognosis. We sought to determine the relationship between daily BPV at 7 days of commencement and functional outcomes during the 3 months following AIS. Methods Altogether, 633 patients with AIS admitted within 72 h of commencement were enrolled. AIS was defined as the time from the onset of symptoms to 7 days. Throughout this period, blood pressure (BP) was recorded twice daily (casual BP cuffs). The daily BPV, with standard deviation (SD) and coefficient of variation (CV), was calculated and matched to the functional results. The adverse outcome was characterized as a modified Rankin scale (mRS)≥3, which comprised the recurrence of stroke, clinical intracranial bleeding, and death. Results In total, 633 participants were included, and the incidence of adverse outcomes was 14.06% (89/633). There was a significant positive correlation between daily BPV and adverse outcomes but not between mean BP and risk. Smooth curve fitting revealed a U-shaped connection between the mean BP and adverse clinical outcomes. Multivariable logistic regression analysis showed an independent correlation between daily BPV and an adverse outcome in the top vs. bottom quartile of systolic BPV (odds ratio [OR] = 2.4, 95% confidence interval [CI]: 1.17-4.96, P = 0.018 for SD; OR = 2.4, 95% CI: 1.17-4.93, P = 0.017 for CV) during a 3-month follow-up period. Identical results have been reported for diastolic BPV. Conclusion Irrespective of BP level, elevated daily systolic BPV and diastolic BPV in AIS were associated with an increased risk of adverse outcomes within 3 months. We also discovered a U-shaped association between the mean BP and adverse clinical outcomes. These findings suggested that BPV should be a risk factor for adverse outcomes after ischemic stroke, which provided new insight into BP management strategy.
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Affiliation(s)
- Yuan Zhu
- Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Minghua Wu
- Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Huihui Wang
- Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Yawei Zheng
- Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Siqi Zhang
- Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Xintong Wang
- Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Shana Wang
- Department of Clinical Medicine, Hangzhou Medical College, Hangzhou, China
| | - Zhuyuan Fang
- Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China,*Correspondence: Zhuyuan Fang ✉
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Yousufuddin M, Murad MH, Peters JL, Ambriz TJ, Blocker KR, Khandelwal K, Pagali SR, Nanda S, Abdalrhim A, Patel U, Dugani S, Arumaithurai K, Takahashi PY, Kashani KB. Within-Person Blood Pressure Variability During Hospitalization and Clinical Outcomes Following First-Ever Acute Ischemic Stroke. Am J Hypertens 2023; 36:23-32. [PMID: 36130108 DOI: 10.1093/ajh/hpac106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 09/19/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Uncertainty remains over the relationship between blood pressure (BP) variability (BPV), measured in hospital settings, and clinical outcomes following acute ischemic stroke (AIS). We examined the association between within-person systolic blood pressure (SBP) variability (SBPV) during hospitalization and readmission-free survival, all-cause readmission, or all-cause mortality 1 year after AIS. METHODS In a cohort of 862 consecutive patients (age [mean ± SD] 75 ± 15 years, 55% women) with AIS (2005-2018, follow-up through 2019), we measured SBPV as quartiles of standard deviations (SD) and coefficient of variation (CV) from a median of 16 SBP readings obtained throughout hospitalization. RESULTS In the cumulative cohort, the measured SD and CV of SBP in mmHg were 16 ± 6 and 10 ± 5, respectively. The hazard ratios (HR) for readmission-free survival between the highest vs. lowest quartiles were 1.44 (95% confidence interval [CI] 1.04-1.81) for SD and 1.29 (95% CI 0.94-1.78) for CV after adjustment for demographics and comorbidities. Similarly, incident readmission or mortality remained consistent between the highest vs. lowest quartiles of SD and CV (readmission: HR 1.29 [95% CI 0.90-1.78] for SD, HR 1.29 [95% CI 0.94-1.78] for CV; mortality: HR 1.15 [95% CI 0.71-1.87] for SD, HR 0.86 [95% CI 0.55-1.36] for CV). CONCULSIONS In patients with first AIS, SBPV measured as quartiles of SD or CV based on multiple readings throughout hospitalization has no independent prognostic implications for the readmission-free survival, readmission, or mortality. This underscores the importance of overall patient care rather than a specific focus on BP parameters during hospitalization for AIS.
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Affiliation(s)
- Mohammed Yousufuddin
- Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, Minnesota, USA
| | - M H Murad
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, Minnesota, USA.,Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jessica L Peters
- Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, Minnesota, USA
| | - Taylor J Ambriz
- Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, Minnesota, USA
| | - Katherine R Blocker
- Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, Minnesota, USA
| | - Kanika Khandelwal
- Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, Minnesota, USA
| | - Sandeep R Pagali
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sanjeev Nanda
- Division of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ahmed Abdalrhim
- Division of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Urvish Patel
- Icahn School of Medicine, Mount Sinai, New York, USA
| | - Sagar Dugani
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Paul Y Takahashi
- Division of Community Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Kianoush B Kashani
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
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Polychronopoulos G, Milonas D, Tziomalos K. Blood Pressure Variability in Patients With Acute Ischemic Stroke: Is It Worth Measuring? Am J Hypertens 2023; 36:17-18. [PMID: 36239116 DOI: 10.1093/ajh/hpac116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/12/2022] [Indexed: 12/30/2022] Open
Affiliation(s)
- Georgios Polychronopoulos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Dimitrios Milonas
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
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Pedro T, Pereira P, Costa AS, Almeida F, Loureiro ML, Alfaiate T, Gonçalves A. Systolic blood pressure variability within 120 hours of admission predicts the functional outcomes at discharge of patients with acute ischemic stroke. JOURNAL OF NEUROCRITICAL CARE 2022. [DOI: 10.18700/jnc.210038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Yao MX, Qiu DH, Zheng WC, Zhao JH, Yin HP, Liu YL, Chen YK. Effects of Early-Stage Blood Pressure Variability on the Functional Outcome in Acute Ischemic Stroke Patients With Symptomatic Intracranial Artery Stenosis or Occlusion Receiving Intravenous Thrombolysis. Front Neurol 2022; 13:823494. [PMID: 35345407 PMCID: PMC8957087 DOI: 10.3389/fneur.2022.823494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 02/08/2022] [Indexed: 12/03/2022] Open
Abstract
Background Studies exploring the relationship between blood pressure (BP) fluctuations and outcome in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT) are limited. We aimed to investigate the influence of blood pressure variability (BPV) during the first 24 h after IVT on early neurological deterioration (END) and 3-month outcome after IVT in terms of different stroke subtypes. Methods Clinical data from consecutive AIS patients who received IVT were retrospectively analyzed. The hourly systolic BP of all patients were recorded during the first 24 h following IVT. We calculated three systolic BPV parameters, including coefficient of variability (CV), standard deviation of mean BP (SD) and successive variation (SV), within the first 6, 12, and 24 h after IVT. END was defined as neurological deterioration with an increase in the National Institutes of Health Stroke Scale (NIHSS) score ≥ 4 points within the first 72 h after admission. Follow-up was performed at 90 days after onset, and favorable and poor outcomes were defined as a modified Rankin Scale scores (mRS) of ≤1 or ≥2, respectively. Results A total of 339 patients, which were divided into those with (intracranial artery stenosis or occlusion group, SIASO group) and without (non-SIASO group) SIASO, were included. Among them, 110 patients (32.4%) were with SIASO. Patients in SIASO group had higher NIHSS on admission and difference in term of mRS at 90 days compared with non-SIASO group (P < 0.001). In SIASO group, patients in favorable outcome group were younger and had lower NIHSS on admission, lower SV-24 h (14.5 ± 4.3 vs. 11.8 ± 3.2, respectively) and lower SD-24 h (12.7 ± 3.8 vs. 10.9 ± 3.3, respectively), compared with patients with poor outcome (all P < 0.05). In the multivariable logistic regression analysis, compared with the lowest SV (SV < 25% quartile), SV50−75% [odds ratio (OR) = 4.449, 95% confidence interval (CI) = 1.231–16.075, P = 0.023] and SV>75% (OR = 8.676, 95% CI = 1.892–39.775, P = 0.005) were significantly associated with poor outcome at 3 months in patients with SIASO, adjusted for age, NIHSS on admission and atrial fibrillation. No BPV parameters were associated with END in SIASO group. In non-SIASO group, there were no significant association between BPV patterns and END or 90-day outcome. Conclusions SV-24 h had a negative relationship with 3-month outcome in AIS patients with SIASO treated with IVT, indicating that BPV may affect the outcome of AIS.
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The First 24 h Hemodynamic Management in NICU after Revascularization Surgery in Moyamoya Disease. Behav Neurol 2021; 2021:5061173. [PMID: 34691282 PMCID: PMC8536456 DOI: 10.1155/2021/5061173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/25/2021] [Indexed: 11/18/2022] Open
Abstract
Objective To evaluate whether hemodynamic factors are risk factors for prognosis in moyamoya disease (MMD). Materials and Methods The retrospective study reviewed a single-center MMD cohort in Huashan Hospital from August 2017 to January 2020. Stroke events in 30 days and follow-up modified Rankin Scale (mRS) grade were recorded. Systematic assessments with perioperative mean arterial pressure (MAP), red blood cell (RBC) parameters, and fluid management were also conducted. Logistic regressions were applied to evaluate the predictors of worse outcomes. Data was analyzed using SPSS 24.0. Results Admission to neurological intensive care unit (NICU) totalled about 347 after revascularization surgery. The result showed that the higher the postoperative MAP level (favorable group 95.7 ± 11.4 mmHg vs. unfavorable group 103.6 ± 10.4 mmHg, p < 0.001) and the greater the MAP variability (favorable group 0.26 ± 13.2 vs. unfavorable group 7.2 ± 13.5, p = 0.006) were, the higher the patient's follow-up mRS grade was. What is more, a higher early postoperative Hb level also seemed to predict a worse long-term clinical outcome (favorable group 116.9 ± 17.1 g/L vs. unfavorable group 123.7 ± 13.0 g/L, p = 0.03), but the difference disappeared after adjusting sex and age. Logistic regression analyses showed that a higher level of postoperative MAP (β = 0.024, 95% CI (0.004, 0.044), and p = 0.02) within the first 24 h in NICU might be the short-term risk factor. For long-term outcome, a higher level (β = 1.058, 95% CI (1.022, 1.096), and p = 0.001) and a greater variability (β = 30.982, 95% CI (2.112, 454.414), and p = 0.01) of postoperative MAP might be the negative predictors of mRS grade. Conclusions The early postoperative hemodynamic management might be extremely critical for patients with MMD. Both high postoperative MAP levels and large MAP variability might affect the prognosis. What is more, we also found that a higher postoperative Hb level might be related with a worse outcome.
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Fukuda K, Matsuo R, Kamouchi M, Kiyuna F, Sato N, Nakamura K, Hata J, Wakisaka Y, Ago T, Imaizumi T, Kai H, Kitazono T. Day-by-Day Blood Pressure Variability in the Subacute Stage of Ischemic Stroke and Long-Term Recurrence. Stroke 2021; 53:70-78. [PMID: 34496621 DOI: 10.1161/strokeaha.120.033751] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE This study aimed to determine whether variability of day-by-day blood pressure (BP) during the subacute stage of acute ischemic stroke is predictive of long-term stroke recurrence. METHODS We analyzed 7665 patients (mean±SD age: 72.9±13.1 years; women: 42.4%) hospitalized for first-ever ischemic stroke in 7 stroke centers in Fukuoka, Japan, from June 2007 to November 2018. BP was measured daily during the subacute stage (4-10 days after onset). Its mean and coefficient of variation (CV) values were calculated and divided into 4 groups according to the quartiles of these BP parameters. Patients were prospectively followed up for recurrent stroke or all-cause death. The cumulative event rate was calculated with the Kaplan-Meier method. We estimated the hazard ratios and 95% confidence intervals of the events of interest after adjusting for potential confounders and mean BP values using Cox proportional hazards models. The Fine-Gray model was also used to account for the competing risk of death. RESULTS With a mean (±SD) follow-up duration of 3.9±3.2 years, the rates of recurrent stroke and all-cause death were 3.9 and 9.9 per 100 patient-years, respectively. The cumulative event rates of recurrent stroke and all-cause death increased with increasing CVs of systolic BP and diastolic BP. The systolic BP CV was significantly associated with an increased risk of recurrent stroke after adjusting for multiple confounders and mean BP (hazard ratio [95% CI] for fourth quartile versus first quartile, 1.26 [1.05-1.50]); the risk of recurrent stroke also increased with an increasing systolic BP CV for nonfatal strokes (1.26 [1.05-1.51]) and when death was regarded as a competing risk (1.21 [1.02-1.45]). Similar associations were observed for the diastolic BP CV. CONCLUSIONS Day-by-day variability of BP during the subacute stage of acute ischemic stroke was associated with an increased long-term risk of recurrent stroke.
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Affiliation(s)
- Kenji Fukuda
- Department of Medicine and Clinical Science (K.F., R.M., F.K., N.S., K.N., J.H., Y.W., T.A., T.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Cerebrovascular Disease, St. Mary's Hospital, Kurume, Japan (K.F.).,Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine, Japan (K.F., T.I.)
| | - Ryu Matsuo
- Department of Medicine and Clinical Science (K.F., R.M., F.K., N.S., K.N., J.H., Y.W., T.A., T.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Health Care Administration and Management (R.M., M.K., N.S.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masahiro Kamouchi
- Department of Health Care Administration and Management (R.M., M.K., N.S.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Center for Cohort Studies (M.K., J.H., T.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Fumi Kiyuna
- Department of Medicine and Clinical Science (K.F., R.M., F.K., N.S., K.N., J.H., Y.W., T.A., T.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Noriko Sato
- Department of Medicine and Clinical Science (K.F., R.M., F.K., N.S., K.N., J.H., Y.W., T.A., T.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Health Care Administration and Management (R.M., M.K., N.S.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kuniyuki Nakamura
- Department of Medicine and Clinical Science (K.F., R.M., F.K., N.S., K.N., J.H., Y.W., T.A., T.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Jun Hata
- Department of Medicine and Clinical Science (K.F., R.M., F.K., N.S., K.N., J.H., Y.W., T.A., T.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Center for Cohort Studies (M.K., J.H., T.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Epidemiology and Public Health (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshinobu Wakisaka
- Department of Medicine and Clinical Science (K.F., R.M., F.K., N.S., K.N., J.H., Y.W., T.A., T.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tetsuro Ago
- Department of Medicine and Clinical Science (K.F., R.M., F.K., N.S., K.N., J.H., Y.W., T.A., T.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tsutomu Imaizumi
- Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine, Japan (K.F., T.I.).,Fukuoka International University of Health and Welfare, Japan (T.I.)
| | - Hisashi Kai
- Department of Cardiology, Kurume University Medical Center, Japan (H.K.)
| | - Takanari Kitazono
- Department of Medicine and Clinical Science (K.F., R.M., F.K., N.S., K.N., J.H., Y.W., T.A., T.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Center for Cohort Studies (M.K., J.H., T.K.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Zhao J, Yuan F, Fu F, Liu Y, Xue C, Wang K, Yuan X, Li D, Liu Q, Zhang W, Jia Y, He J, Zhou J, Wang X, Lv H, Huo K, Li Z, Zhang B, Wang C, Li L, Li H, Yang F, Jiang W. Blood pressure variability and outcome in acute severe stroke: A post hoc analysis of CHASE-A randomized controlled trial. J Clin Hypertens (Greenwich) 2020; 23:96-102. [PMID: 33226186 PMCID: PMC8029725 DOI: 10.1111/jch.14090] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 11/29/2022]
Abstract
The influence of blood pressure variability (BPV) on outcomes in patients with severe stroke is still largely unsettled. Using the data of CHASE trial, the authors calculated the BPV during the acute phase and subacute phase of severe stroke, respectively. The primary outcome was to investigate the relationship between BPV and 90‐day modified Rankin scale (mRS) ≥ 3. The BPV was assessed by eight measurements including standard deviation (SD), mean, maximum, minimum, coefficient of variation (CV), successive variation (SV), functional successive variation (FSV), and average real variability (ARV). Then, the SD of SBP was divided into quintiles and compared the quintile using logistic regression in three models. The acute phase included 442 patients, and the subacute phase included 390 patients. After adjustment, six measurements of BPV during the subacute phase rather than acute phase were strongly correlated with outcomes including minimum (odds ratio [OR]: 0.83, 95% confidence interval [CI]: 0.69‐0.99, p = .037), SD (OR: 1.10, 95% CI: 1.03‐1.17, p = .007), CV (OR: 1.12, 95% CI: 1.03‐1.23, p = .012), ARV (OR: 1.13, 95% CI: 1.05‐1.20, p < .001), SV (OR: 1.09, 95% CI: 1.04‐1.15, p = .001), and FSV (OR: 1.12, 95% CI: 1.05‐1.19, p = .001). In the logistic regression, the highest fifth of SD of SBP predicted poor outcome in all three models. In conclusion, the increased BPV was strongly correlated with poor outcomes in the subacute phase of severe stroke, and the magnitude of association was progressively increased when the SD of BP was above 12.
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Affiliation(s)
- Jingjing Zhao
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Fang Yuan
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Feng Fu
- Department of Neurology, 215 Hospital of Shaanxi NI, Xianyang, China
| | - Yi Liu
- Department of Neurology, Ankang Central Hospital, Ankang, China
| | - Changhu Xue
- Department of Neurology, Xianyang Central Hospital, Xianyang, China
| | - Kangjun Wang
- Department of Neurology, Hanzhong Central Hospital, Hanzhong, China
| | - Xiangjun Yuan
- Department of Neurology, Weinan Central Hospital, Weinan, China
| | - Dingan Li
- Department of Neurology, Hanzhong Central Hospital, Hanzhong, China
| | - Qiuwu Liu
- Department of Neurology, Xi'an 141 Hospital, Xi'an, China
| | - Wei Zhang
- Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Yi Jia
- Department of Neurology, Xi'an Gaoxin Hospital, Xi'an, China
| | - Jianbo He
- Department of Neurology, Xi'an XD Group Hospital, Xi'an, China
| | - Jun Zhou
- Department of Neurology, Shangluo Central Hospital, Shangluo, China
| | - Xiaocheng Wang
- Department of Neurology, Yulin No. 2 Central Hospital, Yulin, China
| | - Hua Lv
- Department of Neurology, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Kang Huo
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zhuanhui Li
- Department of Neurology, 521 Hospital of NORINCO Group, Xi'an, China
| | - Bei Zhang
- Department of Neurology, The First Affiliated Hospital of Xi'an Medical University, Xi'an, China
| | - Chengkai Wang
- Department of Neurology, Tongchuan People's Hospital, Tongchuan, China
| | - Li Li
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,The Shaanxi Cerebrovascular Disease Clinical Research Center, Xi'an, China
| | - Hongzeng Li
- Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Fang Yang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,The Shaanxi Cerebrovascular Disease Clinical Research Center, Xi'an, China
| | - Wen Jiang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.,The Shaanxi Cerebrovascular Disease Clinical Research Center, Xi'an, China
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11
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Yang C, Liu K, Song Y, Gong S, Ye R, Zhang Z, Chen X. Day-by-Day Blood Pressure Variability Is Associated With Neurological Functional Outcome After Acute Ischemic Stroke. Front Neurol 2020; 11:566825. [PMID: 33281703 PMCID: PMC7691487 DOI: 10.3389/fneur.2020.566825] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/05/2020] [Indexed: 02/05/2023] Open
Abstract
Background: Increased blood pressure variability (BPV) might be a detrimental factor after acute ischemic stroke. Previous studies on the association between blood pressure variability in the acute ischemic stroke and functional outcome have yielded inconsistent results. We aimed to investigate the impact of day-by-day blood pressure variability within 7 days of onset on functional outcome at 3 months after acute ischemic stroke. Methods: Total 367 patients hospitalized for ischemic stroke within 48 h of onset were enrolled. The acute stage of ischemic stroke was defined as the time period from symptom onset to 7 days. During this period, blood pressure was measured twice daily (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.). Day-by-day blood pressure variability, including standard deviation (SD) and coefficient variation (CV) were derived and compared to functional outcome. We dichotomized function outcome according to mRS score and unfavorable outcome was defined as mRS ≥3. Results: The patients with unfavorable outcome had significantly higher systolic BPV (within 7 days of onset) than those with favorable outcome (15.41 ± 4.59 vs. 13.42 ± 3.95 mmHg for SD, P < 0.001; 11.54 ± 3.23 vs. 10.41 ± 2.82 for CV, P = 0.001). Multivariable logistic regression analysis revealed that systolic BPV was significantly and independently associated with the 3-month functional outcome [odds ratio (OR) = 1.15, 95% confidence interval (CI): 1.07–1.22, P < 0.001 for SD; OR = 1.15, 95% CI: 1.06–1.26, P = 0.001 for CV]. In addition, After adjustment for multiple confounding factors, including age, gender, risk factors, stroke features, baseline severity, recanalized therapy, hemorrhagic transformation, pulmonary infection, white blood cell, estimated Glomerular Filtration Rate and mean BP, day-by-day BP variability was significantly correlated with an unfavorable outcome in the top vs. bottom quartile of systolic BPV (OR = 3.33, 95% CI: 1.41–7.85, P = 0.006 for SD; OR = 2.27, 95% CI: 1.04–4.94, P = 0.037 for CV) during 3-month follow-up. Similar trends were also observed for diastolic BPV. More importantly, incorporating SD of systolic BP into the conventional prediction model could significantly increase the AUC for prediction of 3-month unfavorable outcome after acute ischemic stroke (0.84 vs. 0.86; P = 0.0416). Conclusions: Increased day-by-day blood pressure variability of systolic or diastolic BP in the acute ischemic stroke was associated with higher risk for unfavorable outcome at 3 months independent of blood pressure levels. Combining SD of systolic BP with conventional risk factors could improve the prediction of unfavorable outcome.
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Affiliation(s)
| | - Kai Liu
- West China Hospital, Sichuan University, Chengdu, China
| | - Yue Song
- West China Second University Hospital, Sichuan University, Chengdu, China
| | - Shenzhen Gong
- West China Hospital, Sichuan University, Chengdu, China
| | - Runyu Ye
- West China Hospital, Sichuan University, Chengdu, China
| | - Zhipeng Zhang
- West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoping Chen
- West China Hospital, Sichuan University, Chengdu, China
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12
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Blood Pressure Variability during Angiography in Patients with Ischemic Stroke and Intracranial Artery Stenosis. Int J Hypertens 2020; 2020:6214581. [PMID: 32953170 PMCID: PMC7481956 DOI: 10.1155/2020/6214581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 11/17/2022] Open
Abstract
Our aim was to investigate factors predicting blood pressure (BP) variability during diagnostic cerebral angiography and associations between BP variability and clinical outcomes in patients with acute and subacute ischemic stroke and intracranial artery stenosis. 114 patients with ischemic stroke and intracranial artery stenosis (stenosis rate >50%) were recruited. Patients who underwent cerebral angiography within 3 days and 3-14 days of disease onset are referred to be Group A and Group S, respectively. BP variability in Group A was defined as the coefficient of variance (CV) of BP. Univariate and multivariate regression analyses were used to identify predictors of CV of BP and associations between CV of BP and clinical outcomes at discharge. In Group A patients, advanced age was associated with increased CV of SBP and diastolic blood pressure (DBP), and antihypertensive use was associated with lower CV of SBP. Male was associated with lower CV of DBP. In Group S, higher CV of SBP was associated with hypertension and antihypertensive use. Males had lower CV of SBP than females. The calcium channel blocker was associated with lower CV of DBP. Higher scores of the Stroke Scale at admission were significantly associated with poor clinical outcomes for both groups, while BP variability was not. Factors associated with BP variability are significantly different between stroke patients undergoing angiography within 3 days vs. 3-14 days after disease onset. BP variability is not significantly associated with clinical outcomes at discharge.
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13
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Thatikonda N, Khandait V, Shrikhande A, Singh K. Role of 24-Hr Blood Pressure Variability as a Target Therapeutic Risk Factor for Poor Functional Outcome of Acute Ischemic Stroke. Ann Indian Acad Neurol 2020; 23:25-31. [PMID: 32055118 PMCID: PMC7001437 DOI: 10.4103/aian.aian_373_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 08/20/2019] [Accepted: 09/29/2019] [Indexed: 11/23/2022] Open
Abstract
Background and Purpose: The present study aims to evaluate the role of blood pressure variability (BPV) as a target therapeutic risk factor for poor outcome of ischemic stroke by finding the association between the two and by finding the population attributable risk (PAR) of BPV compared to other baseline outcome predictors. Methods: A prospective observational study was carried out at GMCH, Nagpur, India from January to June 2019 in 75 patients diagnosed with acute ischemic stroke. BP was recorded hourly for the first 24 hours of admission and base line factors were collected along with measurement of stroke severity. BPV was measured by index of average real-time variability (ARV) while discharge outcome was measured by Barthel Index. Results: 36.5% of patients had poor outcome at discharge. A significant association was found between 24-hr ARV of systolic BP and poor outcome (P = 0.002, 95% CI = 2.22-23.5). Five factors were found to be independent outcome predictors on multiple logistic regression (OR, 95% CI): age (1.07, 1.03–1.10), NIHSS score (1.12, 1.04–1.27), on admission SBP (5.12, 4.01–16.23), on admission RBS (2.23, 1.92–6.49) and 24 Hr ARV-SBP (9.65, 3.02–20.1). The PAR of 24 hr ARV-SBP was 23.6%, second only to NIHSS score (26.4%). Conclusions: Reduction in BP variability might have a beneficial impact on the outcome of patients with acute ischemic stroke. There is further scope to explore optimum therapeutic strategies to minimize BPV in the management of acute ischemic stroke.
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Affiliation(s)
- Nithisha Thatikonda
- Undergraduate Medical Student, Govt. Medical College Nagpur, MUHS, Nagpur, Maharashtra, India
| | - Vinod Khandait
- Department of Medicine, Govt. Medical College Nagpur, MUHS, Nagpur, Maharashtra, India
| | - Aditya Shrikhande
- Undergraduate Medical Student, Govt. Medical College Nagpur, MUHS, Nagpur, Maharashtra, India
| | - Krittika Singh
- Undergraduate Medical Student, Govt. Medical College Nagpur, MUHS, Nagpur, Maharashtra, India
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14
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Blood pressure characteristics in patients with acute basilar artery occlusion undergoing endovascular thrombectomy. Sci Rep 2019; 9:13224. [PMID: 31519971 PMCID: PMC6744431 DOI: 10.1038/s41598-019-49769-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 08/30/2019] [Indexed: 01/01/2023] Open
Abstract
Acute basilar artery occlusion (BAO) is a rare but potentially life-threatening neurological condition. While endovascular therapy (EVT) has been shown to improve outcome, there is limited knowledge about prognostic factors beyond early recanalization. We studied whether blood pressure (BP) exceeds or falls below suggested thresholds during intervention and whether these changes are associated with complications and outcome. BP measurements mostly with one-minute intervals were available in 39 patients. An individual systolic blood pressure (SBP) reference value was defined as the median of the first five intra-procedural measurements. Half of the patients (51.3%) received drugs for BP augmentation and two a BP lowering drug (5.1%). Thrombolysis in cerebral infarction grade 2b and 3 (TICI) was achieved in 29 (74.4%) and 23 patients (58.9%) had good outcome at three months. We observed a continuous intra-procedural increase of median SBP (+11%) and mean arterial pressure (MAP, +10%, both p < 0.001), and a unique temporal pattern of intermittent peaks and troughs. Successful recanalization was more common in patients whose intra-procedural duration with SBP under 140 mmHg was shorter (p = 0.009). Patients with isolated tip of basilar artery (TBA) occlusion had significantly more BP excursion of 20% below the reference SBP and required more frequent use of sympathomimetic drugs compared to vertebrobasilar occlusion (p = 0.008 and p = 0.041, respectively). Brain hemorrhage was more prevalent in patients who experienced SBP excursions at least 20% above the individual reference value (p = 0.038) and a longer duration of time spent with SBP above 180 mmHg (p = 0.029). Patients with higher pre-procedural mean SBP had a greater chance of a good outcome (p = 0.03). This study using high resolution BP monitoring suggests a relationship between intra-procedural BP characteristics and recanalization, hemorrhagic complications and outcome in patients receiving EVT for acute posterior circulation cerebrovascular syndromes. Differences with regard to BP regulation during recanalization therapy for vertebrobasilar and TBA occlusion deserves further attention.
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15
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Xu J, Liu Y, Wang A, Gao Y, Wang Y, Wang Y. Blood pressure fluctuation pattern and stroke outcomes in acute ischemic stroke. Hypertens Res 2019; 42:1776-1782. [PMID: 31451721 DOI: 10.1038/s41440-019-0292-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 04/23/2019] [Accepted: 05/23/2019] [Indexed: 11/09/2022]
Abstract
Blood pressure (BP) fluctuates widely during the acute phase of stroke. Compared to single BP assessment, patterns of BP over time may have greater power in predicting stroke outcome. This study aims to investigate the effect of BP fluctuation patterns on stroke outcomes in acute ischemic stroke (IS) patients. IS patients within 24 h of onset registered in the BOSS registry between 2012 and 2014 were analyzed. Fluctuation of BP was predefined as the change trend in systolic BP (SBP) from Day 1 to Day 7 after onset and was used to divide patients into groups with sustained high SBP (≥160 mmHg) during the first 7 days (C1); rapid (C2: within the first 2 days) or delayed (C3: after 2 days) decline from high (≥160 mmHg) to low (<160 mmHg); consistently low SBP (C4); and elevation from low to high (C5). The primary stroke outcome was defined as a modified Rankin Scale score ≥3 at 3 months after onset. Of 1,095 IS patients, C1 (n = 90) had the highest risk of poor outcome (23.3%), while C2 (n = 198, risk = 11.6%) and C4 (n = 650, risk = 12.2%) had the lowest risk. C2 and C4 had a significant reduction in poor outcome risk when compared to C1, even after adjustment for average BP and BP variability (BPV) during the first 7 days (adjusted odds ratio[OR]C2 = 0.32, 95% CI: 0.12-0.80; ORC4 = 0.37, 95% CI: 0.14-0.97). The BP fluctuation pattern in the acute phase of IS might be a useful predictive parameter for functional outcome independent of average BP and BPV.
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Affiliation(s)
- Jie Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Ying Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yuan Gao
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. .,China National Clinical Research Center for Neurological Diseases, Beijing, China. .,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China. .,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.
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16
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Sweid A, Atallah E, Saad H, Bekelis K, Chalouhi N, Dang S, Li J, Kumar A, Turpin J, Barsoom R, Tjoumakaris S, Hasan D, DePrince M, Labella G, Rosenwasser RH, Jabbour P. Correlation between pre-admission blood pressure and outcome in a large telestroke cohort. J Clin Neurosci 2019; 62:33-37. [PMID: 30660477 DOI: 10.1016/j.jocn.2019.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 01/03/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Telemedicine rapidly connects patients, with acute ischemic stroke symptoms, with neurovascular specialists for assessment to reduce chemical thrombolysis delivery times. Management of AIS includes maintaining target systolic blood pressures (SBP). In this retrospective study, we assess the efficacy of the telestroke (TS) system at a primary stroke center and the prognostic value of SBP throughout the transportation process. METHODS Patients presenting with acute-onset neurological symptoms to the TS hospitals network, over a 5-year period, were assessed. Those with a confirmed diagnosis of AIS were included. We examined demographics, presenting-NIHSS, last SBP before transfer from the network hospital and continuous BP during transport, stroke risk factors, hospital-course, door-to-needle (DTN) time, treatments, and modified Rankin Scale(mRS). Multivariate analysis was conducted to evaluate the prognostic value of SBP on stroke outcome. RESULTS Of 2,928 patients identified, 1,353 were diagnosed with AIS. Mean age was 66.6 years (SD = 15.4), 47.6% female. Most cases affected the MCA(44.5%). Mean presenting-NIHSS was 8.67(SD = 8.38) and mean SBP was 148 mmHg(SD = 25.39). 73.2% treated using a standard protocol, 23.7% given IVrt-PA, and 6.8% received mechanical thrombectomy(MT). Mean DTN was 96 min(SD = 46; 27.3% <60 min). Age, presenting-NIHSS and pre-existing hypertension were associated with higher mortality and/or higher mRS. SBP was not associated with higher mortality and morbidity. CONCLUSIONS This study displays better clinical outcomes at latest follow-up when compared to current international TS studies. SBP during transportation to the hub hospital did not prove to be a useful prognostic metric. However, future studies should address the limitations of this study to confirm these findings.
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Affiliation(s)
- Ahmad Sweid
- Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States.
| | - Elias Atallah
- Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States.
| | - Hassan Saad
- Department of Neurological Surgery, Arkansas Neurosciences Institute, Little Rock, AR, United States
| | - Kimon Bekelis
- Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States
| | - Nohra Chalouhi
- Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States.
| | - Sophia Dang
- Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States.
| | - Jonathan Li
- Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States.
| | - Ayan Kumar
- Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States.
| | - Justin Turpin
- Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States.
| | - Randa Barsoom
- Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States.
| | - Stavropoula Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States.
| | - David Hasan
- Department of Neurological Surgery, University of Iowa, Department of Neurosurgery, Iowa City, IA, United States.
| | - Maureen DePrince
- Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States.
| | - Giuliana Labella
- Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States.
| | - Robert H Rosenwasser
- Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States.
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States.
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17
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Zhang HX, Fan QX, Xue SZ, Zhang M, Zhao JX. Twenty-four-hour blood pressure variability plays a detrimental role in the neurological outcome of hemorrhagic stroke. J Int Med Res 2018; 46:2558-2568. [PMID: 29865917 PMCID: PMC6124278 DOI: 10.1177/0300060518760463] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Blood pressure variability (BPV) is a modifiable risk factor for stroke. This study was performed to determine the prognostic role of BPV in patients with acute hemorrhagic stroke. Methods The data of 131 hospitalized hypertensive patients with spontaneous intracerebral hemorrhage (sICH) were collected. All patients underwent examinations using several neurological scales (Glasgow Coma Scale, National Institutes of Health Stroke Scale, and modified Rankin scale [mRS]) and BP measurements at different time points. Results Sex, age, hematoma volume, and neurological scores were not significantly different between patients with a favorable and unfavorable prognosis for sICH. However, significant differences were found in hypertension, diabetes, metabolic syndrome, atrial fibrillation, smoking, and stroke history. The standard deviation (SD), coefficient of variation (CV), and maximum–minimum range (Max–Min) of diastolic BP and the mean, SD, CV, and Max–Min of systolic BP significantly differed between the groups. Statistical analysis also demonstrated correlations between the 90-day mRS score and BPV and between systolic BPV and the 90-day mRS score. Conclusion High systolic or diastolic BPV within 24 hours of hemorrhagic stroke onset is associated with the 90-day neurological prognosis. The 24-hour BPV plays a critical role in the neurological outcome of hemorrhagic stroke.
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Affiliation(s)
- Huan-Xin Zhang
- Department of Cardiology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei Province, China
| | - Qun-Xiong Fan
- Department of Cardiology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei Province, China
| | - Shi-Zhen Xue
- Department of Cardiology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei Province, China
| | - Min Zhang
- Department of Cardiology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei Province, China
| | - Ji-Xian Zhao
- Department of Cardiology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei Province, China
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18
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Kitamura J, Ueno H, Nagai M, Hosomi N, Honjo K, Nakamori M, Mukai T, Imamura E, Nezu T, Aoki S, Ohshita T, Nomura E, Wakabayashi S, Maruyama H, Matsumoto M. Blood Pressure Variability in Acute Ischemic Stroke: Influence of Infarct Location in the Insular Cortex. Eur Neurol 2018; 79:90-99. [DOI: 10.1159/000486306] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 12/12/2017] [Indexed: 11/19/2022]
Abstract
Background: The aim of this study was to elucidate the influence of insular infarction on blood pressure (BP) variability and outcomes according to the region of the insular cortex affected. Methods: A total of 90 patients diagnosed with acute unilateral ischemic stroke were registered. The BP variability was calculated over 24 h after admission (hyperacute) and for 2–3 days after admission (acute). Patients were classified into groups of right and left, and then right anterior, right posterior, left anterior, and left posterior insular infarction. Results: Patients with insular infarction showed a significantly larger infarct volume, higher modified Rankin scale scores, and lower SD and coefficient of variation (CV) of systolic BP in the hyperacute phase than shown by patients without insular infarction (p < 0.01, p < 0.01, p = 0.02, and p = 0.03, respectively). The SD and CV of systolic BP in the hyperacute phase showed significant differences among the 3 groups with right insular infarction, with left insular infarction, and without insular infarction (p < 0.05 and p < 0.05, respectively). There was a tendency for the systolic BP variability to be lower in patients with right anterior insular infarction than in patients with infarcts in other areas. Conclusion: The right insular cortex, especially the anterior part, might be a hub for autonomic nervous regulation.
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19
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Zhang Y, Wang H, Xu K, Wang P, Li XY, Zhao JB, Tang Y. Ambulatory blood pressure variability within the first 24 hours after admission and outcomes of acute ischemic stroke. ACTA ACUST UNITED AC 2018; 12:195-203. [PMID: 29396105 DOI: 10.1016/j.jash.2017.12.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 12/02/2017] [Accepted: 12/22/2017] [Indexed: 10/18/2022]
Abstract
Our purpose was to evaluate the value of blood pressure variability within the first 24 hours after admission in predicting outcomes of patients with acute ischemic stroke (AIS). A greater variability in systolic blood pressure (adjusted odds ratio [OR] = 1.801, 95% confidence interval [CI] = 1.167-2.779) was associated with poor discharge outcome, especially for nondiabetics (adjusted OR = 1.948, 95% CI = 1.184-3.205) and cardioembolism-related patients with AIS (OR = 7.650, 95% CI = 1.370-42.713). However, this correlation was not observed with a long-term (3-month or 6-month) outcome in patients with AIS. There was no association between diastolic blood pressure variability within the first 24 hours after admission and outcome. In conclusion, systolic blood pressure variability within the first 24 hours after admission is a critical predictor for short-term outcome of patients with AIS.
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Affiliation(s)
- Yu Zhang
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, P. R. China
| | - Hong Wang
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, P. R. China
| | - Ke Xu
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, P. R. China
| | - Ping Wang
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, P. R. China
| | - Xin-Yan Li
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, P. R. China
| | - Jing-Bo Zhao
- Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, Heilongjiang Province, P. R. China.
| | - Ying Tang
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, P. R. China.
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20
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Kellert L, Hametner C, Ahmed N, Rauch G, MacLeod MJ, Perini F, Lees KR, Ringleb PA. Reciprocal Interaction of 24-Hour Blood Pressure Variability and Systolic Blood Pressure on Outcome in Stroke Thrombolysis. Stroke 2017; 48:1827-1834. [PMID: 28546325 DOI: 10.1161/strokeaha.117.016876] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/03/2017] [Accepted: 04/20/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE Significance and management of blood pressure (BP) changes in acute stroke care are unclear. Here, we aimed to investigate the impact of 24-hour BP variability (BPV) on outcome in patients with acute ischemic stroke treated with intravenous thrombolysis. METHODS From the Safe Implementation of Treatment in Stroke International Stroke Thrombolysis registry, 28 976 patients with documented pre-treatment systolic BP at 2 and 24 hours were analyzed. The primary measure of BP variability was successive variability. Data were preprocessed using coarsened exact matching. We assessed early neurological improvement, symptomatic intracerebral hemorrhage (SICH), and long-term functional outcome (modified Rankin Scale [mRS] at 90 days) by binary and ordinal regression analyses. RESULTS Attempts to explain successive variation for analysis of BPV with patients characteristics at admission found systolic BP (5.5% variance) to be most influential, yet 92% of BPV variance remained unexplained. Independently from systolic BP, successive variation for analysis of BPV was associated with poor functional outcome mRS score of 0 to 2 (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.90-0.98), disadvantage across the shift of mRS (OR, 1.04; 95% CI, 1.01-1.08), mortality (OR, 1.10; 95% CI, 1.01-1.08), SICHSITS (OR, 1.14; 95% CI, 1.06-1.23), and SICHECASS (OR, 1.24; 95% CI, 1.10-1.40; ECASS [European Cooperative Acute Stroke Study 2]). Analyzing successive variation for analysis of BPV as a function of pre-treatment, systolic BP significantly improved the prediction of functional outcome (mRS score of 0-1, mRS score of 0-2, neurological improvement, mRS-shift: all Pinteraction<0.01). Excluding patients with atrial fibrillation in a sensitivity analysis gave consistent results overall. CONCLUSIONS This study suggests the need for a more individual BP management accounting for pre-treatment BP and the acute BP course (ie, BPV) to achieve best possible outcome for the patient.
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Affiliation(s)
- Lars Kellert
- From the Department of Neurology, Klinikum der Universität München, Ludwig-Maximilians-University, Germany (L.K.); Department of Neurology, University of Heidelberg (L.K., C.H., P.A.R.) and Institute of Medical Biometry and Informatics (G.R.), University of Heidelberg, Germany; Department of Clinical Neuroscience, Karolinska Institute and Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (N.A.); Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany (G.R.); Division of Applied Medicine, University of Aberdeen, Foresterhill, United Kingdom (M.J.M.); Department of Neurology, St. Bortolo Hospital, Vicenza, Italy (F.P.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (K.R.L.).
| | - Christian Hametner
- From the Department of Neurology, Klinikum der Universität München, Ludwig-Maximilians-University, Germany (L.K.); Department of Neurology, University of Heidelberg (L.K., C.H., P.A.R.) and Institute of Medical Biometry and Informatics (G.R.), University of Heidelberg, Germany; Department of Clinical Neuroscience, Karolinska Institute and Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (N.A.); Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany (G.R.); Division of Applied Medicine, University of Aberdeen, Foresterhill, United Kingdom (M.J.M.); Department of Neurology, St. Bortolo Hospital, Vicenza, Italy (F.P.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (K.R.L.)
| | - Niaz Ahmed
- From the Department of Neurology, Klinikum der Universität München, Ludwig-Maximilians-University, Germany (L.K.); Department of Neurology, University of Heidelberg (L.K., C.H., P.A.R.) and Institute of Medical Biometry and Informatics (G.R.), University of Heidelberg, Germany; Department of Clinical Neuroscience, Karolinska Institute and Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (N.A.); Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany (G.R.); Division of Applied Medicine, University of Aberdeen, Foresterhill, United Kingdom (M.J.M.); Department of Neurology, St. Bortolo Hospital, Vicenza, Italy (F.P.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (K.R.L.)
| | - Geraldine Rauch
- From the Department of Neurology, Klinikum der Universität München, Ludwig-Maximilians-University, Germany (L.K.); Department of Neurology, University of Heidelberg (L.K., C.H., P.A.R.) and Institute of Medical Biometry and Informatics (G.R.), University of Heidelberg, Germany; Department of Clinical Neuroscience, Karolinska Institute and Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (N.A.); Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany (G.R.); Division of Applied Medicine, University of Aberdeen, Foresterhill, United Kingdom (M.J.M.); Department of Neurology, St. Bortolo Hospital, Vicenza, Italy (F.P.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (K.R.L.)
| | - Mary J MacLeod
- From the Department of Neurology, Klinikum der Universität München, Ludwig-Maximilians-University, Germany (L.K.); Department of Neurology, University of Heidelberg (L.K., C.H., P.A.R.) and Institute of Medical Biometry and Informatics (G.R.), University of Heidelberg, Germany; Department of Clinical Neuroscience, Karolinska Institute and Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (N.A.); Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany (G.R.); Division of Applied Medicine, University of Aberdeen, Foresterhill, United Kingdom (M.J.M.); Department of Neurology, St. Bortolo Hospital, Vicenza, Italy (F.P.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (K.R.L.)
| | - Francesco Perini
- From the Department of Neurology, Klinikum der Universität München, Ludwig-Maximilians-University, Germany (L.K.); Department of Neurology, University of Heidelberg (L.K., C.H., P.A.R.) and Institute of Medical Biometry and Informatics (G.R.), University of Heidelberg, Germany; Department of Clinical Neuroscience, Karolinska Institute and Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (N.A.); Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany (G.R.); Division of Applied Medicine, University of Aberdeen, Foresterhill, United Kingdom (M.J.M.); Department of Neurology, St. Bortolo Hospital, Vicenza, Italy (F.P.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (K.R.L.)
| | - Kennedy R Lees
- From the Department of Neurology, Klinikum der Universität München, Ludwig-Maximilians-University, Germany (L.K.); Department of Neurology, University of Heidelberg (L.K., C.H., P.A.R.) and Institute of Medical Biometry and Informatics (G.R.), University of Heidelberg, Germany; Department of Clinical Neuroscience, Karolinska Institute and Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (N.A.); Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany (G.R.); Division of Applied Medicine, University of Aberdeen, Foresterhill, United Kingdom (M.J.M.); Department of Neurology, St. Bortolo Hospital, Vicenza, Italy (F.P.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (K.R.L.)
| | - Peter A Ringleb
- From the Department of Neurology, Klinikum der Universität München, Ludwig-Maximilians-University, Germany (L.K.); Department of Neurology, University of Heidelberg (L.K., C.H., P.A.R.) and Institute of Medical Biometry and Informatics (G.R.), University of Heidelberg, Germany; Department of Clinical Neuroscience, Karolinska Institute and Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (N.A.); Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany (G.R.); Division of Applied Medicine, University of Aberdeen, Foresterhill, United Kingdom (M.J.M.); Department of Neurology, St. Bortolo Hospital, Vicenza, Italy (F.P.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (K.R.L.)
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Milonas D, Tziomalos K. Blood Pressure Variability: Does it Predict the Outcome of Acute Ischemic Stroke? Am J Hypertens 2017; 30:476-477. [PMID: 28199999 DOI: 10.1093/ajh/hpx019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 02/02/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Dimitrios Milonas
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
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Weiss A, Rudman Y, Beloosesky Y, Akirov A, Shochat T, Grossman A. High blood pressure variability predicts 30-day mortality but not 1-year mortality in hospitalized elderly patients. Blood Press 2017; 26:259-263. [PMID: 28270031 DOI: 10.1080/08037051.2017.1300859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The association of blood pressure (BP) variability (BPV) in hospitalized patients, which represents day-to-day variability, with mortality has been extensively reported in patients with stroke, but poorly defined for other medical conditions. AIM AND METHOD To assess the association of day-to-day blood pressure variability in hospitalized patients, 10 BP measurements were obtained in individuals ≥75 years old hospitalized in a geriatric ward. Day-to-day BPV, measured 3 times a day, was calculated in each patient as the coefficient of variation of systolic BP. Patients were stratified by quartiles of coefficient of variation of systolic BP, and 30-day and 1-year mortality data were compared between those in the highest versus the lowest (reference) group. RESULTS Overall, 469 patients were included in the final analysis. Mean coefficient of variation of systolic BP was 12.1%. 30-day mortality and 1-year mortality occurred in 29/469 (6.2%) and 95/469 (20.2%) individuals respectively. Patients in the highest quartile of BPV were at a significantly higher risk for 30-day mortality (HR =4.12, CI 1.12-15.10) but not for 1-year mortality compared with the lowest BPV quartile (HR =1.61, CI 0.81-3.23). CONCLUSIONS Day-to-day BPV is associated with 30-day, but not with 1-year mortality in hospitalized elderly patients.
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Affiliation(s)
- Avraham Weiss
- a Department of Geriatrics , Rabin Medical Center, Beilinson campus , Petah Tikva , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Yaron Rudman
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,c Internal Medicine E , Rabin Medical Center, Beilinson campus , Petah Tikva , Israel
| | - Yichayaou Beloosesky
- a Department of Geriatrics , Rabin Medical Center, Beilinson campus , Petah Tikva , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Amit Akirov
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,d Unit of Endocrinology and Metabolism , Rabin Medical Center, Beilinson campus , Petah Tikva , Israel
| | - Tzippy Shochat
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,e Bio-statistical Unit , Rabin Medical Center, Beilinson Campus , Petah Tikva , Israel
| | - Alon Grossman
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,c Internal Medicine E , Rabin Medical Center, Beilinson campus , Petah Tikva , Israel
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