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Prognostic Impact of Blood Pressure Change Patterns on Patients With Aortic Dissection After Admission

Zhaoyu Wu1, Yixuan Li2,3,4, Peng Qiu1,2

  • 1Department of Vascular Surgery, School of Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, China.

Frontiers in Cardiovascular Medicine
|June 20, 2022
PubMed

Insights

Blood pressure changes significantly impact aortic dissection prognosis. Patients with accelerating systolic blood pressure rises face higher adverse event risks, while decelerating drops indicate better outcomes within 24 hours.

Area of Science:

  • Cardiovascular Medicine
  • Medical Statistics
  • Vascular Surgery

Background:

  • Hypertension is a primary risk factor for aortic dissection (AD).
  • Effective blood pressure (BP) management is crucial for AD patient prognosis.
  • The precise relationship between BP change patterns and AD outcomes remains incompletely understood.

Purpose of the Study:

  • To investigate the impact of systolic blood pressure (SBP) change patterns on the prognosis of patients with aortic dissection.
  • To identify specific SBP variation patterns associated with adverse events in AD patients.

Main Methods:

  • Retrospective analysis of 458 aortic dissection patients from two institutions (2004-2018).
  • Functional data analysis (FDA) applied to categorize SBP change patterns (accelerating rise, accelerating drop, decelerating rise, decelerating drop).
  • Survival analysis (Kaplan-Meier) used to assess the relationship between SBP patterns and adverse events (AEs).

Main Results:

  • High SBP variation was associated with a significantly higher incidence of AEs compared to low SBP variation (35.84% vs. 20.35%).
  • Patients exhibiting a decelerating SBP drop showed a significantly lower incidence of AEs at 15 and 20 minutes compared to those with an accelerating rise.
  • No significant differences in AEs were observed among the four SBP pattern groups at later time points (25 and 30 minutes).

Conclusions:

  • Aortic dissection patients can be categorized into four SBP change patterns within the first 30 minutes post-admission.
  • Accelerating SBP rises correlate with the highest risk of AEs, whereas decelerating SBP drops suggest the best prognosis within 24 hours.
  • Monitoring in-hospital SBP patterns offers valuable prognostic insights for clinicians managing AD.
Abstract

Keywords:
adverse eventsaortic dissectionblood pressureclassificationfunctional data analysis

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