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Stroke. 2015 Jul;46(7):1832-9. doi: 10.1161/STROKEAHA.115.009076. Epub 2015 Jun 11.

Day-by-Day Blood Pressure Variability and Functional Outcome After Acute Ischemic Stroke: Fukuoka Stroke Registry.

Author information

1
From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (K.F., J.H., T.A., T.K.), Department of Health Care Administration and Management, Graduate School of Medical Sciences (M.K.), and Center for Cohort Studies, Graduate School of Medical Sciences (M.K., J.H., T.K.), Kyushu University, Fukuoka, Japan; Department of Cerebrovascular Disease, St. Mary's Hospital, Kurume, Japan (K.F.); Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine, Kurume, Japan (K.F., H.K., T.I.); Cerebrovascular and Neurology Center, National Hospital Organization Fukuoka-Higashi Medical Center, Koga, Japan (H.N.); and International University of Health and Welfare, Fukuoka Sannou Hospital, Fukuoka, Japan (T.I.).
2
From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (K.F., J.H., T.A., T.K.), Department of Health Care Administration and Management, Graduate School of Medical Sciences (M.K.), and Center for Cohort Studies, Graduate School of Medical Sciences (M.K., J.H., T.K.), Kyushu University, Fukuoka, Japan; Department of Cerebrovascular Disease, St. Mary's Hospital, Kurume, Japan (K.F.); Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine, Kurume, Japan (K.F., H.K., T.I.); Cerebrovascular and Neurology Center, National Hospital Organization Fukuoka-Higashi Medical Center, Koga, Japan (H.N.); and International University of Health and Welfare, Fukuoka Sannou Hospital, Fukuoka, Japan (T.I.). kamouchi@hcam.med.kyushu-u.ac.jp.

Abstract

BACKGROUND AND PURPOSE:

The relationship between blood pressure (BP) variability and functional outcome in patients with acute ischemic stroke remains unclear. This study aimed to elucidate whether in-hospital day-by-day BP variability is associated with functional outcome after acute ischemic stroke.

METHODS:

Using the Fukuoka Stroke Registry, we included 2566 patients with a first-ever ischemic stroke who had been functionally independent before the onset and were hospitalized within 24 hours. BP was measured daily, and its variability was assessed by SD, coefficients of variance, and variations independent of mean. Poor functional outcome was assessed by modified Rankin Scale scores ≥3 at 3 months.

RESULTS:

After adjustment for multiple confounding factors including age, sex, risk factors, stroke features, baseline severity, thrombolytic therapy, antihypertensive agents, and mean BP, day-by-day BP variability during the subacute stage (4-10 days after onset) was independently associated with a poor functional outcome (multivariable-adjusted odds ratios [95% confidence interval] in the top versus bottom quartile of systolic BP variability, 1.51 [1.09-2.08] for SD; 1.63 [1.20-2.22] for coefficients of variance; 1.64 [1.21-2.24] for variations independent of mean). Similar trends were also observed for diastolic BP variability. These trends were unchanged in patients who were not treated with antihypertensive drugs. In contrast, no association was found between indices of BP variability during the acute stage and functional outcome after adjusting for potential confounders.

CONCLUSIONS:

These data suggest that intraindividual day-by-day BP variability during the subacute stage is associated with the 3-month functional outcome after acute ischemic stroke.

KEYWORDS:

blood pressure; cerebral infarction; prognosis; risk factors; stroke

PMID:
26069262
DOI:
10.1161/STROKEAHA.115.009076
[Indexed for MEDLINE]

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