Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Dec 18;12(12):e0189216.
doi: 10.1371/journal.pone.0189216. eCollection 2017.

Change in blood pressure variability in patients with acute ischemic stroke and its effect on early neurologic outcome

Jihoon Kang  1 , Jeong-Ho Hong  2 , Min Uk Jang  3 , Nack Cheon Choi  4 , Ji Sung Lee  5 , Beom Joon Kim  1 , Moon-Ku Han  1 , Hee-Joon Bae  1
Affiliations

Change in blood pressure variability in patients with acute ischemic stroke and its effect on early neurologic outcome

Jihoon Kang et al. PLoS One. .

Abstract

Background: How short-term blood pressure variability (BPV) is affected in the acute stage of ischemic stroke and whether BPV is associated with early neurologic outcomes remains unclear.

Methods: Patients who admitted for ischemic stroke within 24 h of symptom onset were consecutively identified between January 2010 and January 2015. BP profiles measured in real-time were summarized into short-term, 24-h time intervals, based on standard deviation (SD) and mean of systolic BP (SBPSD) during the first 3 days. The primary outcome was daily assessment of early neurological deterioration (END). The associations between short-term SBPSD values and the secular trend for primary outcome were examined.

Results: A total of 2,545 subjects (mean age, 67.1 ± 13.5 years old and median baseline National Institutes of Health Stroke Scale score, 3) arrived at the hospital an average of 6.1 ± 6.6 h after symptom onset. SBPSD values at day 1 (SD#D1), SD#D2, and SD#D3 were 14.4 ± 5.0, 12.5 ± 4.5, and 12.2 ± 4.6 mmHg, respectively. Multivariable analyses showed that SD#D2 was independently associated with onset of END at day 2 (adjusted odds ratio, 1.08; 95% confidence interval, 1.03-1.13), and SD#D3 was independently associated with END#D3 (1.07, 1.01-1.14), with adjustments for predetermined covariates, SBPmean, and interactions with daily SBPSD.

Conclusion: Short-term BPV changed and stabilized from the first day of ischemic stroke. Daily high BPV may be associated with neurological deterioration independent of BPV on the previous day.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Statistical association between SBPSD and primary outcomes.
Daily SBPSD values were investigated for END#D1(A), END#D2 (B), and END#D3 (C). In multivariable analysis, the interaction term SD#D1 × SD#D2 was included in model B and SD#D1 × SD#D2, SD#D1 × SD#D3, SD#D2 × SD#D3, and SD#D1 × SD#D2 × SD#D3 were included in model C.
Fig 2
Fig 2. Comparisons of daily SBP parameters according to daily END.
The daily means (A) and standard deviations (B) of SBP are shown as patients with END (box) and without END (circle).
See this image and copyright information in PMC

References

    1. Willmot M, Leonardi-Bee J, Bath PMW. High Blood Pressure in Acute Stroke and Subsequent Outcome: A Systematic Review. Hypertension. 2004;43: 18–24. doi: 10.1161/01.HYP.0000105052.65787.35 - DOI - PubMed
    1. Goldstein LB. Blood Pressure Management in Patients With Acute Ischemic Stroke. Hypertension. 2004;43: 137–141. doi: 10.1161/01.HYP.0000113297.76013.51 - DOI - PubMed
    1. Rothwell PM. Limitations of the usual blood-pressure hypothesis and importance of variability, instability, and episodic hypertension. The Lancet. Elsevier Ltd; 2010;375: 938–948. doi: 10.1016/S0140-6736(10)60309-1 - DOI - PubMed
    1. Delgado-Mederos R, Ribo M, Rovira A, Rubiera M, Munuera J, Santamarina E, et al. Prognostic significance of blood pressure variability after thrombolysis in acute stroke. Neurology. 2008;71: 552–558. doi: 10.1212/01.wnl.0000318294.36223.69 - DOI - PubMed
    1. Ko Y, Park JH, Yang MH, Ko S-B, Han MK, Oh CW, et al. The significance of blood pressure variability for the development of hemorrhagic transformation in acute ischemic stroke. Stroke. 2010;41: 2512–2518. doi: 10.1161/STROKEAHA.110.595561 - DOI - PubMed