Predictive Significance of Day-to-Day Blood Pressure Variability in Acute Ischemic Stroke for 12-Month Functional Outcomes

<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">BACKGROUND</div>Previous studies on the association between blood pressure (BP) variability in acute ischemic stroke and functional outcomes have yielded conflicting results. We aimed to investigate the predictive significance of day-to-day BP variability during the 7 days following stroke onset for functional outcomes at 12 months.<div class="boxTitle">METHODS</div>A total of 229 patients (male 68.8%, mean age 66.7 ± 13.0 years) within 24 hours after onset were prospectively studied. The first 24 hours and day-to-day BP variability, including the SD, coefficient variation (CV), average real variation, and ΔBP (difference between the maximum and minimum BP), were derived and compared to functional outcomes. The functional outcomes were accessed using the baseline severity-adjusted analysis at 12 months post-stroke.<div class="boxTitle">RESULTS</div>The patients with poor outcomes at 12 months had significantly higher morning systolic BP (SBP; 1–3 days after onset) than those with good outcomes. The day-to-day SBP variability parameters (1–7 days) such as SD, CV, and Δ SBP were significantly higher in the patients with poor outcomes than in those with good outcomes (17.0 ± 6.0 vs. 14.8 ± 5.3 mm Hg, 11.8 ± 3.9 vs. 10.6 ± 3.5, 48.3 ± 17.7 vs. 39.9 ± 15.5 mm Hg, respectively; <span style="font-style:italic;">P</span> < 0.05). After adjustment for demographic and clinical features, day-to-day Δ SBP was associated with poorer functional outcomes at 12 months (odds ratio, 95% confidence interval: 1.547, 1.097–2.181). Even after adjusting for the mean SBP, Δ SBP was independently associated with 12-month poor functional outcomes (odds ratio, 95% confidence interval: 1.577, 1.095–2.272).<div class="boxTitle">CONCLUSIONS</div>Day-to-day SBP variability in acute ischemic stroke was associated with poor functional outcomes at 12 months.<div class="boxTitle">CLINICAL TRIALS REGISTRATION</div>Trial Number NCT02675972</span>

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