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Int J Stroke. 2018 Jul;13(5):473-480. doi: 10.1177/1747493017729267. Epub 2017 Sep 5.

Blood pressure variability and leukoaraiosis in acute ischemic stroke.

Author information

1 Institute of Cardiovascular and Medical Sciences, Queen Elizabeth University Hospital, University of Glasgow, Glasgow, UK.
2 Brain Research Imaging Centre, The University of Edinburgh, Edinburgh, UK.
3 Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh, UK.
4 Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK.
5 Department of Internal Medicine, Oslo University Hospital, Oslo, Norway.
6 George Institute for Global Health and Discipline of Medicine, University of Sydney, Sydney, New South Wales, Australia.
7 Department of Neuroradiology, University Hospital, Technische Universität Dresden, Germany.
8 Danderyd Hospital, Stockholm, Sweden.
9 Cliniques Universitaires Saint-Luc, Bruxelles, Belgium.
10 School of Pathology and Laboratory Medicine, The University of Western Australia, Crawley, Western Australia.
11 NHS Lothian, Edinburgh, Scotland.
12 Neuroradiology, James Cook University Hospital, South Tees Hospital NHS Trust, Middlesborough, UK.
13 Salford Royal NHS Foundation Trust, Salford, UK.
14 Department of Neurology, Stroke Center, Ospedale Sacro Cuore-Don Calabria, Negrar, Verona, Italy.
15 UK Dementia Research Institute at the University of Edinburgh, Edinburgh, UK.


Higher blood pressure, blood pressure variability, and leukoaraiosis are risk factors for early adverse events and poor functional outcome after ischemic stroke, but prior studies differed on whether leukoaraiosis was associated with blood pressure variability, including in ischemic stroke. In the Third International Stroke Trial, blood pressure was measured in the acute phase of ischemic stroke immediately prior to randomization, and at 0.5, 1, and 24 h after randomization. Masked neuroradiologists rated index infarct, leukoaraiosis, and atrophy on CT using validated methods. We characterized blood pressure variation by coefficient of variance and three other standard methods. We measured associations between blood pressure, blood pressure variability, and leukoaraiosis using generalized estimating equations, adjusting for age, and a number of covariates related to treatment and stroke type/severity. Among 3017 patients, mean (±SD) systolic and diastolic blood pressure decreased from 155(±24)/82(±15) mmHg pre-randomization to 146(±23)/78(±14) mmHg 24 h later ( P < 0.005). Mean within-subject coefficient of variance was 0.09 ± 0.05 for systolic and 0.11 ± 0.06 for diastolic blood pressure. Patients with most leukoaraiosis were older and had higher blood pressure than those with least ( P < 0.0001). Although statistically significant in simple pairwise comparisons, no measures of blood pressure variability were associated with leukoaraiosis when adjusting for confounding variables ( P > 0.05), e.g. age. Our results suggest that blood pressure variability is not a potential mechanism to explain the association between leukoaraiosis and poor outcome after acute stroke.


Blood pressurize; computed tomography; ischemic; leukoaraiosis; stroke; variation


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