Within-person blood pressure variability during hospitalization and clinical outcomes following first-ever acute ischemic stroke

Am J Hypertens. 2022 Sep 20:hpac106. doi: 10.1093/ajh/hpac106. Online ahead of print.

ABSTRACT

BACKGROUND: Uncertainty remains over the relationship between blood pressure variability (BPV), measured in hospital settings, and clinical outcomes following acute ischemic stroke (AIS). We examined the association between within-person systolic blood pressure (SBP) variability (SBPV) during hospitalization and readmission-free survival, all-cause readmission, or all-cause mortality at 1 year after AIS.

METHODS: In a cohort of 862 consecutive patients (age [mean ± SD] 75±15 years, 55% women) with AIS (2005-2018, follow-up through 2019), we measured SBPV as quartiles of standard deviations (SD) and coefficient of variation (CV) from a median of 16 SBP readings obtained throughout hospitalization.

RESULTS: In cumulative cohort, the measured SD and CV of SBP in mmHg were 16±6 and 10±5, respectively. The hazard ratios for the highest vs. lowest quartiles was 1.44 (95% confidence interval 1.04 – 1.81) for SD and 1.29 (95% confidence interval 0.94-1.78) for CV after adjustment for demographics and comorbidities. Similarly, incident readmission or mortality remained consistent between the highest vs. lowest quartiles of SD and CV (readmission: HR 1.29 [95% CI 0.90-1.78] for SD, HR 1.29 [95% CI 0.94-1.78] for CV; mortality: HR 1.15 [95% CI 0.71-1.87] for SD, HR 0.86 [95% CI 0.55-1.36] for CV).

CONCULSIONS: In patients with first AIS, SBPV measured as quartiles of SD or CV based on multiple readings throughout hospitalization have no independent prognostic implications for the readmission-free survival, readmission, or mortality. This underscores the importance of overall patientcare rather than a specific focus on BP parameters during hospitalization for AIS.

PMID:36130108 | DOI:10.1093/ajh/hpac106

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