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Long-term prognostic implications of visit-to-visit blood pressure variability in patients with ischemic stroke
Kui-Kai Lau1, Yuen-Kwun Wong1, Kay-Cheong Teo1
1Division of Neurology, Department of Medicine, University of Hong Kong, Hong Kong, China;
Insights
High blood pressure variability (BPV) in systolic readings predicts long-term mortality in ischemic stroke patients. This finding holds true even when average blood pressure is well-controlled, highlighting BPV as a crucial prognostic factor.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Hypertension Research
Background:
- Blood pressure variability (BPV) is an emerging risk factor for atherosclerotic diseases.
- Previous studies linked high BPV to mortality in lacunar infarct patients.
- Prognostic implications of BPV in other ischemic stroke subtypes remain unclear.
Purpose of the Study:
- To investigate the prognostic significance of BPV in patients with ischemic stroke, excluding those with atrial fibrillation.
- To determine if visit-to-visit BPV predicts long-term outcomes such as mortality, recurrent stroke, and acute coronary syndrome.
Main Methods:
- Prospective follow-up of 632 ischemic stroke patients without atrial fibrillation.
- Measurement of average blood pressure and BPV (coefficient of variation) over a mean of 12 clinic visits.
- Statistical analysis adjusting for mean systolic blood pressure and other confounders.
Main Results:
- High systolic BPV significantly predicted cardiovascular mortality (HR=2.36) and all-cause mortality (HR=1.79) after adjustment.
- No association was found between systolic BPV and nonfatal recurrent stroke or acute coronary syndrome.
- Diastolic BPV did not predict any of the studied adverse outcomes.
Conclusions:
- Visit-to-visit systolic BPV is an independent predictor of long-term all-cause and cardiovascular mortality in ischemic stroke patients without atrial fibrillation.
- Systolic BPV provides prognostic information beyond average blood pressure control.
- These findings underscore the importance of monitoring BPV in stroke management.
Background:
Blood pressure (BP) variability (BPV) is a novel risk factor for the development of atherosclerotic diseases. High BPV has recently been shown to predict all-cause and cardiovascular mortality in patients with lacunar infarct. Whether BPV has prognostic implications in patients with ischemic stroke subtypes, other than those due to small-vessel occlusion, remains uncertain.
Methods:
We prospectively followed up the clinical outcome of 632 consecutive ischemic stroke patients without atrial fibrillation. The average BP and BPV, as determined by the coefficient of variation of the systolic and diastolic BP, were recorded during a mean 12 ± 6 outpatient clinic visits.
Results:
The average age of the population was 71 ± 11 years. After a mean of 76 ± 18 months of follow-up, 161 patients died (26%); 35% (n = 56 of 161) of these deaths were due to cardiovascular causes. Sixteen percent and 5% developed recurrent stroke and acute coronary syndrome (ACS), respectively. After adjusting for mean systolic BP and confounding variables, patients with high systolic BPV were at significantly greater risk of cardiovascular mortality (hazards ratio (HR) = 2.36; 95% confidence interval (CI) = 1.02-5.49; P < 0.05). High systolic BPV also predicted all-cause mortality after adjusting for mean systolic BP (HR = 1.79; 95% CI = 1.16-2.75; P < 0.05). There was no association between systolic BPV and nonfatal recurrent stroke or nonfatal ACS. Raised diastolic BPV did not predict recurrent nonfatal stroke, nonfatal ACS, or mortality.
Conclusions:
Visit-to-visit systolic BPV predicts long-term all-cause and cardiovascular mortality in patients with ischemic stroke without atrial fibrillation, independent of other conventional risk factors, including average BP control.