Effect of blood pressure variability on early neurological deterioration in single small subcortical infarction with parental arterial disease

Abstract

Background and purpose: Early neurological deterioration (END) is not uncommon in acute single small subcortical infarct (SSSI), especially in those with parental arterial disease (PAD). The purpose of this study was to elucidate the effect of BP variability on the development of END as well as functional outcome at 90 days in SSSI and to determine whether the effect is linked to the status of parent artery.

Methods: Consecutive patients with acute SSSI were prospectively recruited from the First People's Hospital of Yangzhou between Aug 2013 and Jul 2016. END was defined as an NIHSS score increased ≥ 2 during the first 72 h compared with the initial NIHSS score. Functional outcome at 90 days after onset was assessed using the modified Rankin Score (mRS) and dichotomized as good (0-2) and poor (≥ 3). During this period, the parameters of BP variability such as BP_max-min, BP_SD, and BP_CV (equal to [SD × 100] / mean) were calculated.

Results: A total of 296 patients were included in the analysis. Of these, 30 (38.5%) SSSI associated with PAD and 53 (24.3%) without developed END respectively. Logistic regression analysis demonstrated that SBP_max (OR 1.036, 95% CI 1.005-1.069), SBP_SD (OR 1.177, 95% CI 1.021-1.356), SBPcv (OR 1.306, 95% CI 1.049-1.626), DBP_max (OR 1.141, 95% CI 1.042-1.250), DBP_max-min (OR 1.085, 95% CI 1.015-1.160), DBP_SD (OR 1.369, 95% CI 1.032-1.816), and DBP_CV (OR 1.281, 95% CI 1.028-1.597) were all the independent predictors of END after acute SSSI associated with PAD. However, for those without PAD, none of the BP parameters was found significantly associated with END. Also, BP parameters were not related to the poor outcome at 90 days after onset.

Conclusions: Our study demonstrated that the acute in-hospital BP variability was associated with the development of END in patients with acute SSSI. However, its impact varies depending on the status of parent artery.

Keywords: Blood pressure variability; Early neurological deterioration; Parental arterial disease; Single small subcortical infarct.

Fig. 1

Example of SSSIPAD: a 67 years old man, END was occurred during the first 17 h after onset.

Fig. 2

Example of SSSI without PAD: a 73 years old woman, whose clinical condition had not get worse during the first 72 h after onset.