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J Hypertens. 2019 May 30. doi: 10.1097/HJH.0000000000002126. [Epub ahead of print]

Blood pressure variability in subacute stage and risk of major vascular events in ischemic stroke survivors.

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Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University, Seongnam.
Clinical Research Center, Asan Medical Center, Ulsan University School of Medicine, Seoul, Korea.
Department of Translational Science & Molecular Medicine, Michigan State University College of Human Medicine and Mercy Health Hauenstein Neurosciences, Grand Rapids, Michigan, USA.
Department of Biostatistics, Korea University College of Medicine, Seoul, Korea.



We aimed to investigate whether blood pressure (BP) in the subacute stage of ischemic stroke affects subsequent vascular events after acute ischemic stroke.


From a prospective stroke registry database, consecutive ischemic stroke patients arriving within 48 h of onset were identified. The mean and SD of SBP per patient (SBPmean and SBPSD) in the subacute stage (from 72 h of onset to discharge), were calculated. Primary outcome was a composite of stroke, myocardial infarction and vascular death that occurred within 1 year after hospital discharge. A Cox proportional hazards model was applied to elucidate whether the increase of SBPmean and SBPSD would increase the hazards of the primary outcome.


Of 4415 patients (age, 66.7 ± 13.2 years; men, 69.5%), mean ± SD of SBPmean and SBPSD in the subacute stage was 137.3 ± 15.4 and 13.3 ± 3.9 mmHg, respectively. Primary outcome events occurred in 6.9% during the first year after stroke. There was a significant dose-response relationship between the SBPSD and the risk of the primary outcome (P = 0.004), but not between SBPmean and the risk (P = 0.78). Interpolating the change of adjusted hazard ratio using restricted cubic spine function suggested an existence of a threshold effect of SBPSD and a U-shaped relationship of SBPmean for the composite event.


This study shows that BP variability but not mean BP in the subacute stage of ischemic stroke may increase 1-year risk of major vascular events in patients surviving its acute stage.

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