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Different contribution of SBP and DBP variability to vascular events in patients with stroke
Liye Dai1,2, Aichun Cheng1,2, Xiwa Hao1,3
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Insights
High blood pressure variability (BPV) is a risk factor for cardiovascular disease. Diastolic blood pressure variability (DBPV) is linked to both stroke recurrence and cardiovascular events after TIA or IS, while systolic BPV is only linked to stroke recurrence.
Area of Science:
- Cardiology
- Neurology
- Clinical Research
Background:
- High blood pressure variability (BPV) is an emerging risk factor for cardiovascular disease.
- The distinct contributions of systolic blood pressure variability (SBPV) and diastolic blood pressure variability (DBPV) to various vascular events are not well understood.
- Investigating these differences is crucial for understanding post-stroke/TIA cardiovascular risk.
Purpose of the Study:
- To determine whether SBPV or DBPV has a differential impact on vascular events in patients who have experienced acute ischemic stroke (IS) or transient ischemic attack (TIA).
- To clarify the specific associations between SBPV and DBPV with stroke recurrence versus cardiovascular events.
Main Methods:
- Utilized data from the BOSS study, analyzing vascular events at 3-month and 1-year follow-ups.
- Defined day-to-day BPV using standard deviation (SD) and coefficient of variation (CV) within 3 months post-IS/TIA.
- Employed logistic regression to assess the relationship between SBPV, DBPV, and vascular outcomes (stroke, cardiovascular events).
Main Results:
- In 2325 patients, SBPV was associated with stroke recurrence but not cardiovascular events.
- DBPV showed associations with both stroke recurrence and cardiovascular events.
- These associations were consistent at both 3-month and 1-year follow-up periods.
Conclusions:
- Both SBPV and DBPV contribute to stroke recurrence in patients with IS or TIA.
- DBPV, but not SBPV, appears to be specifically associated with cardiovascular events in this patient cohort.
- Findings highlight the differential prognostic value of SBPV and DBPV for distinct vascular outcomes.
Background:
High blood pressure variability (BPV) is a novel risk factor for cardiovascular disease. However, the heterogeneity of systolic blood pressure variability (SBPV) and diastolic blood pressure variability (DBPV) for different vascular events remains unclear. This study aims to investigate whether SBPV or DBPV has different contribution to vascular events in patients with acute ischaemic stroke (IS) or transient ischaemic attack (TIA).
Methods:
Data from the BOSS (blood pressure and clinical outcome in TIA or IS) study were examined for vascular events at 3-month and 1-year follow-up. BPV was defined as the SD and coefficient of variation (CV) of day-to-day measurements within 3 months after IS/TIA. Vascular events include cardiovascular events (myocardial infarction, unstable angina, cardiac death and congestive heart failure) and cerebrovascular events (ischaemic or haemorrhagic stroke). Logistic regression model was used to test the associations between BPV and vascular events.
Results:
Of 2325 patients with IS or TIA, 103 (4.43 %) experienced a recurrent stroke and 64 (2.75 %) had cardiovascular events within 3 months. Day-to-day SBPV was only associated with stroke recurrence (BPVSD: OR, 1.72, 95% CI 1.09 to 2.71; BPVCV: 1.86, 95% CI 1.19 to 2.92), but not cardiovascular events (BPVSD: 1.67, 95% CI 0.94 to 2.94; BPVCV: 1.51, 95% CI 0.86 to 2.64). However, DBPV seems to be related to both stroke (BPVSD: 1.60, 95% CI 1.02 to 2.49; BPVCV: 1.53, 95% CI 0.99 to 2.37) and cardiovascular events (BPVSD: 2.48, 95% CI 1.37 to 4.48; BPVCV: 1.92, 95% CI 1.09 to 3.36). Similar results were found at 1 year.
Conclusions:
For patients with IS/TIA, stroke recurrence was associated with both SBPV and DBPV; however, cardiovascular events seem to be only related to DBPV.
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