American Journal of Internal Medicine

| Peer-Reviewed |

Average Real Variability of Diastolic Blood Pressure During Acute Phase Could Independently Predict 3-month Functional Outcome for Ischemic Stroke

Received: 29 March 2020    Accepted: 15 April 2020    Published: 30 April 2020
Views:       Downloads:

Share This Article

Abstract

Background and purpose—Blood pressure variability has a significant effect on stroke. There were controversial reports about its relationship with short term functional outcome remains controversial for ischemic stroke or transient ischemic attack (TIA). There were limited studies about its long-term effect. Our aim was to elucidate the effect of BPV on a 3-month functional outcome in patients with acute ischemic stroke or TIA. Methods—In this prospective observational study, a consecutive series of 400 patients were enrolled with acute ischemic stroke or TIA within 7 days. All patients were referred and monitored for BP at 2-hour intervals in the first 24 hours. Afterward, the BP was recorded every four hours up to the 7th day, with 1-hour deviation the daytime and 2 hours at night. All BP results were recorded into an electronic medical record (EMR) system. Average real variability (ARV) was used to analyze the blood pressure variability (BPV). All patients were followed up as planned for 90 days. The primary outcome was evaluated by the modified Rankin Scale (mRS); an unfavorable outcome was mRS≥2. For comparison, patients were respectively divided into two groups based on systolic blood pressure ARV (SBP ARV) or diastolic blood pressure ARV (DBP ARV). A multivariate logistic regression model was used to estimate the effect of between ARV BPV on functional outcomes. Results—Among the 400 patients, 46 (11.4%) had an unfavorable outcome (mRS>2) at 90 days. Their mean 24h DBP ARV was significantly higher than others (10.42±3.63 vs. 9.83±4.27 mm Hg; p=0.03). The high 24hDBPARV was defined above the median of 7.75 mmHg, which was statistically associated with an unfavorable outcome (64.7% vs. 35.3%; P=0.004). Further stepwise logistic regression analysis indicated that 24h high DBPARV was the independent predictor of an unfavorable outcome (adjusted OR 2.44%, 95% confidence interval: 1.24-4.74, P<0.01). Conclusions—High DBPARV during the acute phase is an independent and significant predictor of 90-day functional outcome for ischemic stroke or TIA.

DOI 10.11648/j.ajim.20200803.13
Published in American Journal of Internal Medicine (Volume 8, Issue 3, May 2020)
Page(s) 107-112
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Blood Pressure in Acute Stroke, Ischemic Stroke, Transient Ischemic Attack, Acute Stroke Outcome

References
[1] Mancia G, Grassi G. Mechanisms and clinical implications of blood pressure variability. J Cardiovasc Pharmacol. 2000; 35: S15-19.
[2] Ohkubo T. Prognostic significance of variability in ambulatory and home blood pressure from the Ohasama study. J Epidemiol. 2007; 17: 109-113.
[3] Miao CY, Xie HH, Zhan LS, Su DF. Blood pressure variability is more important than blood pressure level in determination of end-organ damage in rats. J Hypertens. 2006; 24: 1125-1135.
[4] Rothwell PM, Howard SC, Dolan E, O'Brien E, Dobson JE, Dahlöf B, Sever PS, Poulter NR. Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet. 2010; 375: 895-905.
[5] Manning LS, Rothwell PM, Potter JF, Robinson TG. Prognostic Significance of Short-Term Blood Pressure Variability in Acute Stroke: Systematic Review. Stroke. 2015; 46: 2482-2490.
[6] Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJ, Culebras A, Elkind MS, George MG, Hamdan AD, Higashida RT, Hoh BL, Janis LS, Kase CS, Kleindorfer DO, Lee JM, Moseley ME, Peterson ED, Turan TN, Valderrama AL, Vinters HV. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013; 44: 2064-2089.
[7] Mena L, Pintos S, Queipo NV, Aizpúrua JA, Maestre G, Sulbarán T. A reliable index for the prognostic significance of blood pressure variability. J Hypertens. 2005; 23: 505-511.
[8] 1999 World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension. Guidelines Subcommittee. J Hypertens. 1999; 17: 151-183.
[9] Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998; 15: 539-553.
[10] Standards of medical care in diabetes--2011. Diabetes Care. 2011; 34 Suppl 1: S11-61.
[11] Delgado-Mederos R, Ribo M, Rovira A, Rubiera M, Munuera J, Santamarina E, Delgado P, Maisterra O, Alvarez-Sabin J, Molina CA. Prognostic significance of blood pressure variability after thrombolysis in acute stroke. Neurology. 2008; 71: 552-558.
[12] Endo K, Kario K, Koga M, Nakagawara J, Shiokawa Y, Yamagami H, Furui E, Kimura K, Hasegawa Y, Okada Y, Okuda S, Namekawa M, Miyagi T, Osaki M, Minematsu K, Toyoda K. Impact of early blood pressure variability on stroke outcomes after thrombolysis: the SAMURAI rt-PA Registry. Stroke. 2013; 44: 816-818.
[13] Kellert L, Sykora M, Gumbinger C, Herrmann O, Ringleb PA. Blood pressure variability after intravenous thrombolysis in acute stroke does not predict intracerebral hemorrhage but poor outcome. Cerebrovasc Dis. 2012; 33: 135-140.
[14] Manning L, Hirakawa Y, Arima H, Wang X, Chalmers J, Wang J, Lindley R, Heeley E, Delcourt C, Neal B, Lavados P, Davis SM, Tzourio C, Huang Y, Stapf C, Woodward M, Rothwell PM, Robinson TG, Anderson CS. Blood pressure variability and outcome after acute intracerebral haemorrhage: a post-hoc analysis of INTERACT2, a randomised controlled trial. Lancet Neurol. 2014; 13: 364-373.
[15] Sare GM, Ali M, Shuaib A, Bath PM. Relationship between hyperacute blood pressure and outcome after ischemic stroke: data from the VISTA collaboration. Stroke. 2009; 40: 2098-2103.
[16] Yong M, Kaste M. Association of characteristics of blood pressure profiles and stroke outcomes in the ECASS-II trial. Stroke. 2008; 39: 366-372.
[17] Webb AJ, Fischer U, Mehta Z, Rothwell PM. Effects of antihypertensive-drug class on interindividual variation in blood pressure and risk of stroke: a systematic review and meta-analysis. Lancet. 2010; 375: 906-915.
[18] Rothwell PM, Howard SC, Dolan E, O'Brien E, Dobson JE, Dahlöf B, Poulter NR, Sever PS. Effects of beta blockers and calcium-channel blockers on within-individual variability in blood pressure and risk of stroke. Lancet Neurol. 2010; 9: 469-480.
[19] Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg. 2010; 8: 336-341.
[20] Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000; 283: 2008-2012.
[21] Tanaka E, Koga M, Kobayashi J, Kario K, Kamiyama K, Furui E, Shiokawa Y, Hasegawa Y, Okuda S, Todo K, Kimura K, Okada Y, Okata T, Arihiro S, Sato S, Yamagami H, Nagatsuka K, Minematsu K, Toyoda K. Blood pressure variability on antihypertensive therapy in acute intracerebral hemorrhage: the Stroke Acute Management with Urgent Risk-factor Assessment and Improvement-intracerebral hemorrhage study. Stroke. 2014; 45: 2275-2279..
[22] Kang J, Ko Y, Park JH, Kim WJ, Jang MS, Yang MH, Lee J, Lee J, Han MK, Gorelick PB, Bae HJ. Effect of blood pressure on 3-month functional outcome in the subacute stage of ischemic stroke. Neurology. 2012; 79: 2018-2024.
[23] Manning LS, Mistri AK, Potter J, Rothwell PM, Robinson TG. Short-term blood pressure variability in acute stroke: post hoc analysis of the controlling hypertension and hypotension immediately post stroke and continue or stop post-stroke antihypertensives collaborative study trials. Stroke. 2015; 46: 1518-1524.
[24] Dawson SL, Manktelow BN, Robinson TG, Panerai RB, Potter JF. Which parameters of beat-to-beat blood pressure and variability best predict early outcome after acute ischemic stroke. Stroke. 2000; 31: 463-468.
[25] Li Y, Wang JG, Dolan E, Gao PJ, Guo HF, Nawrot T, Stanton AV, Zhu DL, O'Brien E, Staessen JA. Ambulatory arterial stiffness index derived from 24-hour ambulatory blood pressure monitoring. Hypertension. 2006; 47: 359-364.
[26] Macwilliam JA, Melvin GS. Systolic and diastolic blood pressure estimation, with special reference to the auditory method. Br Med J. 1914; 1: 693-697.
[27] Reinhard M, Rutsch S, Lambeck J, Wihler C, Czosnyka M, Weiller C, Hetzel A. Dynamic cerebral autoregulation associates with infarct size and outcome after ischemic stroke. Acta Neurol Scand. 2012; 125: 156-162.
[28] Guo ZN, Liu J, Xing Y, Yan S, Lv C, Jin H, Yang Y. Dynamic cerebral autoregulation is heterogeneous in different subtypes of acute ischemic stroke. PLoS One. 2014; 9: e93213.
Author Information
  • South Campus Outpatient Department, The First Affiliated Hospital, Jinan University, Guangzhou, China

  • South Campus Outpatient Department, The First Affiliated Hospital, Jinan University, Guangzhou, China

  • Department of Haematology, The First Affiliated Hospital of Jinan University, Guangzhou, China

  • Department of Neurology, The First Affiliated Hospital of Jinan University, Guangzhou, China

Cite This Article
  • APA Style

    Wenzhu Liu, Yanping Chen, Xiafeng Wu, Zefeng Tan. (2020). Average Real Variability of Diastolic Blood Pressure During Acute Phase Could Independently Predict 3-month Functional Outcome for Ischemic Stroke. American Journal of Internal Medicine, 8(3), 107-112. https://doi.org/10.11648/j.ajim.20200803.13

    Copy | Download

    ACS Style

    Wenzhu Liu; Yanping Chen; Xiafeng Wu; Zefeng Tan. Average Real Variability of Diastolic Blood Pressure During Acute Phase Could Independently Predict 3-month Functional Outcome for Ischemic Stroke. Am. J. Intern. Med. 2020, 8(3), 107-112. doi: 10.11648/j.ajim.20200803.13

    Copy | Download

    AMA Style

    Wenzhu Liu, Yanping Chen, Xiafeng Wu, Zefeng Tan. Average Real Variability of Diastolic Blood Pressure During Acute Phase Could Independently Predict 3-month Functional Outcome for Ischemic Stroke. Am J Intern Med. 2020;8(3):107-112. doi: 10.11648/j.ajim.20200803.13

    Copy | Download

  • @article{10.11648/j.ajim.20200803.13,
      author = {Wenzhu Liu and Yanping Chen and Xiafeng Wu and Zefeng Tan},
      title = {Average Real Variability of Diastolic Blood Pressure During Acute Phase Could Independently Predict 3-month Functional Outcome for Ischemic Stroke},
      journal = {American Journal of Internal Medicine},
      volume = {8},
      number = {3},
      pages = {107-112},
      doi = {10.11648/j.ajim.20200803.13},
      url = {https://doi.org/10.11648/j.ajim.20200803.13},
      eprint = {https://download.sciencepg.com/pdf/10.11648.j.ajim.20200803.13},
      abstract = {Background and purpose—Blood pressure variability has a significant effect on stroke. There were controversial reports about its relationship with short term functional outcome remains controversial for ischemic stroke or transient ischemic attack (TIA). There were limited studies about its long-term effect. Our aim was to elucidate the effect of BPV on a 3-month functional outcome in patients with acute ischemic stroke or TIA. Methods—In this prospective observational study, a consecutive series of 400 patients were enrolled with acute ischemic stroke or TIA within 7 days. All patients were referred and monitored for BP at 2-hour intervals in the first 24 hours. Afterward, the BP was recorded every four hours up to the 7th day, with 1-hour deviation the daytime and 2 hours at night. All BP results were recorded into an electronic medical record (EMR) system. Average real variability (ARV) was used to analyze the blood pressure variability (BPV). All patients were followed up as planned for 90 days. The primary outcome was evaluated by the modified Rankin Scale (mRS); an unfavorable outcome was mRS≥2. For comparison, patients were respectively divided into two groups based on systolic blood pressure ARV (SBP ARV) or diastolic blood pressure ARV (DBP ARV). A multivariate logistic regression model was used to estimate the effect of between ARV BPV on functional outcomes. Results—Among the 400 patients, 46 (11.4%) had an unfavorable outcome (mRS>2) at 90 days. Their mean 24h DBP ARV was significantly higher than others (10.42±3.63 vs. 9.83±4.27 mm Hg; p=0.03). The high 24hDBPARV was defined above the median of 7.75 mmHg, which was statistically associated with an unfavorable outcome (64.7% vs. 35.3%; P=0.004). Further stepwise logistic regression analysis indicated that 24h high DBPARV was the independent predictor of an unfavorable outcome (adjusted OR 2.44%, 95% confidence interval: 1.24-4.74, PConclusions—High DBPARV during the acute phase is an independent and significant predictor of 90-day functional outcome for ischemic stroke or TIA.},
     year = {2020}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Average Real Variability of Diastolic Blood Pressure During Acute Phase Could Independently Predict 3-month Functional Outcome for Ischemic Stroke
    AU  - Wenzhu Liu
    AU  - Yanping Chen
    AU  - Xiafeng Wu
    AU  - Zefeng Tan
    Y1  - 2020/04/30
    PY  - 2020
    N1  - https://doi.org/10.11648/j.ajim.20200803.13
    DO  - 10.11648/j.ajim.20200803.13
    T2  - American Journal of Internal Medicine
    JF  - American Journal of Internal Medicine
    JO  - American Journal of Internal Medicine
    SP  - 107
    EP  - 112
    PB  - Science Publishing Group
    SN  - 2330-4324
    UR  - https://doi.org/10.11648/j.ajim.20200803.13
    AB  - Background and purpose—Blood pressure variability has a significant effect on stroke. There were controversial reports about its relationship with short term functional outcome remains controversial for ischemic stroke or transient ischemic attack (TIA). There were limited studies about its long-term effect. Our aim was to elucidate the effect of BPV on a 3-month functional outcome in patients with acute ischemic stroke or TIA. Methods—In this prospective observational study, a consecutive series of 400 patients were enrolled with acute ischemic stroke or TIA within 7 days. All patients were referred and monitored for BP at 2-hour intervals in the first 24 hours. Afterward, the BP was recorded every four hours up to the 7th day, with 1-hour deviation the daytime and 2 hours at night. All BP results were recorded into an electronic medical record (EMR) system. Average real variability (ARV) was used to analyze the blood pressure variability (BPV). All patients were followed up as planned for 90 days. The primary outcome was evaluated by the modified Rankin Scale (mRS); an unfavorable outcome was mRS≥2. For comparison, patients were respectively divided into two groups based on systolic blood pressure ARV (SBP ARV) or diastolic blood pressure ARV (DBP ARV). A multivariate logistic regression model was used to estimate the effect of between ARV BPV on functional outcomes. Results—Among the 400 patients, 46 (11.4%) had an unfavorable outcome (mRS>2) at 90 days. Their mean 24h DBP ARV was significantly higher than others (10.42±3.63 vs. 9.83±4.27 mm Hg; p=0.03). The high 24hDBPARV was defined above the median of 7.75 mmHg, which was statistically associated with an unfavorable outcome (64.7% vs. 35.3%; P=0.004). Further stepwise logistic regression analysis indicated that 24h high DBPARV was the independent predictor of an unfavorable outcome (adjusted OR 2.44%, 95% confidence interval: 1.24-4.74, PConclusions—High DBPARV during the acute phase is an independent and significant predictor of 90-day functional outcome for ischemic stroke or TIA.
    VL  - 8
    IS  - 3
    ER  - 

    Copy | Download

  • Sections