Acute in-hospital blood pressure variability predicts early neurological deterioration in acute minor stroke or transient ischemic attack with steno-occlusive arterial disease

Abstract

It is generally known that acute minor stroke and transient ischemic attack (TIA) seem to be benign. However, their occurrence in patients with steno-occlusive arterial disease may result in early neurological deterioration (END). We aimed to elucidate the effect of blood pressure variability (BPV) on the development of END. Consecutive acute minor stroke and TIA patients within 24 hours of onset were prospectively recruited from the Affiliated Hospital of Yangzhou University between Aug 2015 and Feb 2019. END was defined as an NIHSS score increased ≥1 during the first 72 hours compared with the initial NIHSS score. During this period, the mean, maximum (max), the difference between the maximum and minimum (max-min), the SD, and coefficient of variation of BP (BP_CV ) were calculated. Of the 160 total patients enrolled in the study (mean age, 68.01 ± 9.33 years; 50.6% female), 52 (32.5%) patients occurred END during the first 72h after admission. To express the BPV as a categorical variable, we classified the subjects into one of four groups, representing four quartiles of BPV. In the multivariable analyses, the lowest quartiles were considered as reference groups. The results showed that patients who fell in the fourth quartile (SBP_max-min :OR = 3.289, 95% CI 1.147-9.430; SBP_SD :OR = 3.313, 95% CI 1.041-10.547; SBP_CV :OR = 3.425, 95% CI 1.164-10.077; DBP_SD :OR = 3.124, 95% CI 1.065-9.158) had a significantly higher risk of END after adjusting the variables (age, female, diabetes mellitus, atrial fibrillation, and CRP with P values <.1 in univariate analyses). Our study demonstrated that the acute in-hospital BPV was associated with the development of END in acute minor stroke and TIA with steno-occlusive arterial disease.

Keywords: blood pressure; blood pressure variability; early neurological deterioration; minor stroke; transient ischemic attack.

Figure 1

Proportions of patients developing END according to SBP parameters. P values for the association between SBP quintiles and END according to the chi‐square test: P = .171 for SBP_mean; P = .227 for SBP_max; P = .022 for SBP_max‐min; P = .038 for SBP_SD; P = .038 for SBP_CV; CV, coefficient of variation; END, early neurological deterioration; max, maximum; min, minimum; Q, quartile; Q1, the first quartile; Q2, the second quartile; Q3, the third quartile; Q4, the fourth quartile; SBP, systolic blood pressure; SD, standard deviation

Figure 2

Proportions of patients developing END according to DBP parameters. P values for the association between DBP quintiles and END according to the chi‐square test: P = .434 for DBP_mean; P = .096 for DBP_max; P = .013 for DBP_max‐min; P = .004 for DBP_SD; P = .013 for DBP_CV; CV, coefficient of variation; DBP, diastolic blood pressure; max, maximum; min, minimum; Q, quartile; Q1, the first quartile; Q2, the second quartile; Q3, the third quartile; Q4, the fourth quartile; SD: standard deviation