Relation between Blood Pressure Variability within a Single Visit and Stroke

Area of Science:

• Cardiology
• Neurology
• Public Health

Background:

• Blood pressure variability (BPV) is a recognized risk factor for cardiovascular events.
• The white coat effect (WCE), a measure of BPV within a single visit, is quantified by the difference between the first and subsequent blood pressure readings.
• Understanding WCE's impact on stroke risk is crucial for cardiovascular event prediction.

Purpose of the Study:

• To investigate the association between the white coat effect (WCE) and the risk of stroke.
• To determine if BPV within a single clinical visit is an independent predictor of stroke.

Main Methods:

• A cohort of 2,972 participants with three blood pressure measurements per visit was analyzed.
• Participants were stratified into three groups based on WCE percentiles: normal range (WCE_2.5-97.5), low WCE (WCE_2.5), and high WCE (WCE_97.5).
• Multiple logistic regression was employed to assess the relationship between WCE and stroke, adjusting for established cardiovascular disease risk factors.

Main Results:

• The low WCE group (WCE_2.5) exhibited a significantly higher odds ratio (OR) for stroke (OR=2.78, p=0.015) compared to the normal WCE group.
• After adjusting for cardiovascular risk factors, the OR for stroke in the low WCE group remained significant (OR=3.12, p=0.017).
• A significant inverse association was observed between WCE and stroke risk (OR=0.93, p=0.036), suggesting that extreme WCE values, particularly low WCE, may be linked to increased stroke incidence.

Conclusions:

• Blood pressure variability within a single visit, as indicated by the white coat effect, is significantly associated with an increased risk of stroke.
• The magnitude and direction of blood pressure changes during a single visit may be important indicators of stroke risk.
• Monitoring within-visit BPV could offer novel insights into stroke risk stratification and prevention strategies.