Mean arterial pressure and pulse pressure trajectories and clinical outcomes after acute ischemic stroke

Distinct blood pressure (BP) trajectories were observed after acute stroke and associated with clinical outcomes. This study assessed fluctuations of mean arterial pressure (MAP) and pulse pressure (PP) and evaluated the prognostic significance of MAP and PP trajectory patterns after acute ischemic stroke. We included 4008 acute ischemic stroke patients from the China Antihypertensive Trial in Acute Ischemic Stroke. Latent class mixed modeling identified distinct MAP and PP trajectories using 37 repeated measurements during the first 7 days. We identified five distinct trajectories for MAP and PP: high, high to moderate, high to low, moderate stable, and low. Compared with low MAP trajectory, the adjusted odds ratios (ORs) or hazard ratio (HRs) (95% CIs) of high trajectory were 1.92 (1.33-2.75) for the primary outcome of death and major disability and 1.87 (1.00-3.47) for the composite outcome of cardiovascular events and all-cause mortality. Furthermore, the high to moderate MAP trajectory remained associated with the primary outcome. The high PP trajectory was associated with increased risks of the primary outcome, recurrent stroke, and cardiovascular events in the primary analyses. The significant relationships were confirmed in subgroup analyses, stratified by clinical features and antihypertensive intervention. Both MAP and PP trajectory patterns were associated with death, major disability, and cardiovascular events after acute ischemic stroke. Patients with high or high to moderate MAP and PP trajectories had elevated risk of unfavorable clinical outcomes.