Related Experiment Video
Updated: Oct 21, 2025
Real-Time Monitoring and Modulation of Blood Pressure in a Rabbit Model of Ischemic Stroke
Published on: February 10, 2023
Day-by-Day Blood Pressure Variability in the Subacute Stage of Ischemic Stroke and Long-Term Recurrence
Kenji Fukuda1,2,3, Ryu Matsuo1,4, Masahiro Kamouchi4,5
1Department 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.
Insights
Blood pressure variability during acute ischemic stroke recovery predicts long-term stroke recurrence. Higher blood pressure (BP) variation in the subacute stage increases the risk of future strokes.
Area of Science:
- Neurology
- Cardiology
- Public Health
Background:
- Acute ischemic stroke poses a significant risk for long-term recurrence.
- Monitoring blood pressure (BP) during the subacute recovery phase is crucial for patient management.
Purpose of the Study:
- To investigate if day-by-day blood pressure (BP) variability in the subacute stage predicts long-term stroke recurrence.
- To establish the association between BP variability and recurrent stroke risk.
Main Methods:
- Analysis of 7665 patients hospitalized for first-ever ischemic stroke.
- Daily BP measurements during the subacute stage (4-10 days post-onset) to calculate mean and coefficient of variation (CV).
- Prospective follow-up for recurrent stroke and all-cause death, analyzed using Kaplan-Meier, Cox proportional hazards, and Fine-Gray models.
Main Results:
- Increased cumulative event rates for recurrent stroke and all-cause death correlated with higher systolic and diastolic BP CVs.
- Systolic BP CV significantly associated with increased recurrent stroke risk (HR: 1.26 [1.05-1.50] for highest vs. lowest quartile).
- Similar associations observed for diastolic BP CV, including nonfatal strokes and competing risks of death.
Conclusions:
- Day-by-day blood pressure variability in the subacute stage of acute ischemic stroke is a significant predictor of long-term recurrent stroke risk.
- BP variability, not just mean BP, should be considered in post-stroke management strategies.
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.
Related Concept Videos
01:30Hypertension III: Clinical Manifestations and Diagnostic Studies
01:27Regulation of Stroke Volume
Preload refers to the degree of stretch on the heart before it contracts. It's analogous to the stretching of a rubber band; the more it's stretched, the more forcefully it snaps back. This concept is encapsulated in the Frank-Starling law of the...
01:25Errors occurring during blood pressure monitoring
Several factors...
01:17Measurement of Blood Pressure
01:28Factors affecting Blood pressure
Physiological Factors:
01:28Special considerations while measuring blood pressure
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.