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
. 2025 Feb 4;61(2):267.
doi: 10.3390/medicina61020267.

Visit-to-Visit Systolic Blood Pressure Variability and Risk of Ischemic and Hemorrhagic Stroke

Oana Elena Sandu  1   2 , Carina Bogdan  1   2 , Adrian Apostol  1   2 , Larissa Madalina-Alexandra Daniluc  1 , Amanda Claudia Schuldesz  3 , Mihaela Adriana Simu  3   4
Affiliations

Visit-to-Visit Systolic Blood Pressure Variability and Risk of Ischemic and Hemorrhagic Stroke

Oana Elena Sandu et al. Medicina (Kaunas). .

Abstract

Background and Objectives: Systolic blood pressure (SBP) variability has been increasingly associated with cardiovascular outcomes, including stroke. This study aimed to evaluate the association between visit-to-visit SBP variability and the risk of ischemic and hemorrhagic stroke. Materials and Methods: A prospective cohort study was conducted on a set of 208 hypertensive patients over a period of three years, from August 2021 to September 2024, at the County Emergency Hospital "Pius Brinzeu", Timișoara. Patients included in the study were stroke-free. SBP variability was quantified as the standard deviation of SBP measurements obtained quarterly. Results: This study demonstrated that systolic blood pressure (SBP) variability serves as a robust predictor of stroke incidence, underscoring its important role in cerebrovascular risk. The study cohort had an average age of 65.3 ± 9.1 years, with 53.4% males and 46.6% females. Patients in the highest SBP variability group had a 1.21-fold increased risk (21%, p = 0.031) of ischemic stroke and a 1.73-fold increased risk (73%, p = 0.005) of hemorrhagic stroke compared to those in the lowest variability group, revealing that higher SBP variability is strongly associated with an increased risk of both ischemic and hemorrhagic strokes, with the relationship being particularly pronounced for hemorrhagic stroke. Patients exhibiting greater fluctuations in SBP experienced significantly earlier stroke events and reduced stroke-free survival. Moreover, mortality rates were notably higher among individuals with very high SBP variability, indicating its profound impact on long-term outcomes. Conclusions: Visit-to-visit SBP variability is a significant and independent predictor of both ischemic and hemorrhagic stroke, emphasizing the clinical importance of monitoring and managing blood pressure stability. Further research should explore interventions to mitigate SBP variability and its impact on cerebrovascular outcomes.

Keywords: hemorrhagic stroke; ischemic stroke; visit-to-visit systolic blood pressure variability.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Impact of SBP variability on stroke-free survival. SBP: Systolic Blood Pressure; Red: low SBP Variability; Green: high SBP variability; Blue: very high SBP variability group.
Figure 2
Figure 2
Association of SBP Variability and Mortality. SBP: Systolic Blood Pressure; Red: low SBP Variability; Green: high SBP variability; Blue: very high SBP variability group.
See this image and copyright information in PMC

References

    1. Zhou B., Perel P., Mensah G.A., Ezzati M. Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension. Nat. Rev. Cardiol. 2021;18:785–802. doi: 10.1038/s41569-021-00559-8. - DOI - PMC - PubMed
    1. De la Sierra A. Blood Pressure Variability as a Risk Factor for Cardiovascular Disease: Which Antihypertensive Agents Are More Effective? J. Clin. Med. 2023;12:6167. doi: 10.3390/jcm12196167. - DOI - PMC - PubMed
    1. Arboix A., Roig H., Rossich R., Martínez E.M., García-Eroles L. Differences between hypertensive and non-hypertensive ischemic stroke. Eur. J. Neurol. 2004;11:687–692. doi: 10.1111/j.1468-1331.2004.00910.x. - DOI - PubMed
    1. Kario K., Okura A., Hoshide S., Mogi M. The WHO Global report 2023 on hypertension warning the emerging hypertension burden in globe and its treatment strategy. Hypertens. Res. 2024;47:1099–1102. doi: 10.1038/s41440-024-01622-w. - DOI - PubMed
    1. McEvoy J.W., McCarthy C.P., Bruno R.M., Brouwers S., Canavan M.D., Ceconi C., Christodorescu R.M., Daskalopoulou S.S., Ferro C.J., Gerdts E., et al. 2024 ESC Guidelines for the Management of Elevated Blood Pressure and Hypertension: Developed by the Task Force on the Management of Elevated Blood Pressure and Hypertension of the European Society of Cardiology (ESC) and Endorsed by the European Society of Endocrinology (ESE) and the European Stroke Organisation (ESO) Eur. Heart J. 2024;45:3912–4018. doi: 10.1093/eurheartj/ehae178. - DOI - PubMed

MeSH terms

LinkOut - more resources