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Blood Pressure Variability and 90-Day Functional Outcome in Branch Atheromatous Disease-Related Stroke: A Multicenter
Yaping Zhou1, Shengde Li1, Haizhou Hu1
1Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Insights
Elevated systolic blood pressure variability (BPV) in acute Branch Atheromatous Disease (BAD)-related stroke is linked to worse outcomes. Monitoring BPV and stabilizing blood pressure are crucial for managing BAD stroke patients.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Public Health
Background:
- Branch atheromatous disease (BAD)-related stroke has unique prognostic factors, with modifiable ones needing further investigation.
- Systolic blood pressure variability (BPV) is a potential prognostic factor in stroke, but its role in BAD-related stroke is unclear.
Purpose of the Study:
- To investigate the association between systolic BPV and 90-day functional outcomes in patients with BAD-related stroke.
- To determine if BPV predicts early neurological deterioration (END) in BAD-related stroke.
Main Methods:
- Prospective, multicenter study in China involving 423 patients with radiologically confirmed BAD-related stroke.
- Systolic BPV assessed using standard deviation (SD), coefficient of variation (CV), and variation independent of the mean (VIM) during hospitalization.
- Outcomes included poor functional outcome (modified Rankin Scale >2) at 90 days and END within 7 days; multivariable logistic regression used for analysis.
Main Results:
- 13.9% of patients experienced poor functional outcomes at 90 days.
- Higher systolic BPV was significantly associated with an increased risk of END.
- Patients in the highest tertile of systolic BPV had a significantly higher risk of poor 90-day functional outcomes compared to the lowest tertile (ORs ranging from 2.77 to 3.10).
Conclusions:
- Elevated systolic BPV during the acute phase is an independent predictor of END and poor 90-day functional outcomes in BAD-related stroke.
- These findings underscore the importance of monitoring BPV and implementing blood pressure stabilization strategies in managing BAD-related stroke.
- Further research into BPV's role may lead to improved therapeutic interventions for BAD stroke patients.
Abstract:
Branch atheromatous disease (BAD)-related stroke shows distinct prognostic features from other stroke subtypes, with modifiable prognostic factors remaining inconclusive. The present research investigated the association between systolic blood pressure variability (BPV) and 90-day functional outcomes of BAD-related stroke. We enrolled 423 patients (median age 60 years; 70.2% male) with radiologically confirmed BAD from a prospective multicenter study in China. BPV was assessed using standard deviation (SD), coefficient of variation (CV), and variation independent of the mean (VIM) of systolic blood pressure measurements during hospitalization. The primary outcome was a poor functional outcome at 90 days, defined as a modified Rankin Scale (mRS) score >2. The secondary outcome was early neurological deterioration (END) within 7 days. Multivariable logistic regression models were used to evaluate the association between BPV and outcomes. Subgroup and sensitivity analyses were conducted. Overall, 13.9% of patients experienced poor functional outcome. A higher BPV was associated with increased risk of END. Compared with the lowest tertile, patients in the highest tertile of systolic BPV had a significantly increased risk of poor functional outcome (OR: 3.10 for SD, 2.77 for CV, and 2.97 for VIM; all p < 0.05, p for trend <0.05 for all indices). Sensitivity analysis and subgroup analysis results were consistent with the primary findings. In conclusion, elevated systolic BPV during the acute phase is independently associated with END and poor 90-day functional outcome in BAD-related stroke, highlighting the importance of BPV monitoring and blood pressure stabilization in the management of BAD-related stroke.
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