gms | German Medical Science

Background and Purpose: Highly variable blood pressure (BP) profiles are commonly observed in acute ischemic stroke patients. Management of BP is based mainly on baseline or average level, within-patient variability is rarely addressed. The aim of the study is to find out the association of long-term functional outcome and mortality with blood pressure variability in the acute phase.

Materials and Methods: We studied 793 patients with acute ischemic hemispheric stroke in the second European Cooperative Acute Stroke Study (ECASS). After randomization, BP was measured regularly during the first 24 hours. Successive variation, which takes the serial variation on the time sequence into account, was adopted to measure the within-patient BP variability. The endpoints were favorable outcome (modified Rankin Scale [mRS] score of 0 or 1) and all-cause mortality at day 90. Logistic regression models were used to adjust for the baseline characteristics.

Results: Favorable outcome was inversely associated with variability of systolic BP profiles (adjusted odds ratio [OR]: 0.57; 95% CI: 0.35 - 0.92, and OR: 0.41; 95% CI: 0.22 - 0.76, per 10 mmHg) respectively in rt-PA and placebo treated patients. Higher variability of diastolic BP profiles implied unfavorable outcome (OR: 0.54; 95% CI: 0.30 – 0.98) and higher mortality (OR: 2.87; 95% CI: 1.30 – 6.32) in rt-PA treated patients.

Conclusions: Association of favorable outcome with lower variability of BP during the first 24 hours may give new hint for the BP management in the acute ischemic stroke.