Cargando…
Increased blood pressure variability after acute ischemic stroke increases the risk of death: A secondary analysis of the Virtual International Stroke Trial Archive
BACKGROUND: Despite promising epidemiological data, it remains unclear if increased blood pressure variability is associated with death after acute ischemic stroke. Our objective was to examine this association in a large cohort of acute ischemic stroke patients. METHODS: We conducted a retrospectiv...
Autores principales: | , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6560789/ https://www.ncbi.nlm.nih.gov/pubmed/31217966 http://dx.doi.org/10.1177/2048004019856496 |
_version_ | 1783426021540757504 |
---|---|
author | de Havenon, Adam Stoddard, Greg Saini, Monica Wong, Ka-Ho Tirschwell, David Bath, Phillip |
author_facet | de Havenon, Adam Stoddard, Greg Saini, Monica Wong, Ka-Ho Tirschwell, David Bath, Phillip |
author_sort | de Havenon, Adam |
collection | PubMed |
description | BACKGROUND: Despite promising epidemiological data, it remains unclear if increased blood pressure variability is associated with death after acute ischemic stroke. Our objective was to examine this association in a large cohort of acute ischemic stroke patients. METHODS: We conducted a retrospective analysis of anonymized, pooled, participant data from the Virtual International Stroke Trial Archive. We included patients with a 90-day modified Rankin Scale and blood pressure readings in the 24 h after study enrollment. The exposure was blood pressure variability during the day after study enrollment, calculated for the systolic and diastolic blood pressure using six statistical methodologies. The primary outcome was death within 90 days of stroke onset. RESULTS: Our cohort comprised 1891 patients of whom 277 (14.7%) died within 90 days. All indices of blood pressure variability were higher in patients who died, but the difference was more pronounced for systolic than diastolic blood pressure variability (systolic standard deviation for alive versus dead patients = 13.4 versus 15.9 mmHg, p < 0.001). Similar results were found in logistic regression models fit to the outcome of death, but only systolic blood pressure variability remained significant in adjusted models (Odds Ratio for death when comparing highest to lowest tercile of systolic blood pressure variability = 1.41–1.89, p < 0.03 for all). Conclusions and relevance: These results reinforce prior studies that found increased blood pressure variability is associated with worse neurologic outcome after stroke. These data should help guide research on blood pressure variability after stroke and advocate for the inclusion of death as a clinical outcome in future studies that therapeutically reduce blood pressure variability. |
format | Online Article Text |
id | pubmed-6560789 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-65607892019-06-19 Increased blood pressure variability after acute ischemic stroke increases the risk of death: A secondary analysis of the Virtual International Stroke Trial Archive de Havenon, Adam Stoddard, Greg Saini, Monica Wong, Ka-Ho Tirschwell, David Bath, Phillip JRSM Cardiovasc Dis Research Paper BACKGROUND: Despite promising epidemiological data, it remains unclear if increased blood pressure variability is associated with death after acute ischemic stroke. Our objective was to examine this association in a large cohort of acute ischemic stroke patients. METHODS: We conducted a retrospective analysis of anonymized, pooled, participant data from the Virtual International Stroke Trial Archive. We included patients with a 90-day modified Rankin Scale and blood pressure readings in the 24 h after study enrollment. The exposure was blood pressure variability during the day after study enrollment, calculated for the systolic and diastolic blood pressure using six statistical methodologies. The primary outcome was death within 90 days of stroke onset. RESULTS: Our cohort comprised 1891 patients of whom 277 (14.7%) died within 90 days. All indices of blood pressure variability were higher in patients who died, but the difference was more pronounced for systolic than diastolic blood pressure variability (systolic standard deviation for alive versus dead patients = 13.4 versus 15.9 mmHg, p < 0.001). Similar results were found in logistic regression models fit to the outcome of death, but only systolic blood pressure variability remained significant in adjusted models (Odds Ratio for death when comparing highest to lowest tercile of systolic blood pressure variability = 1.41–1.89, p < 0.03 for all). Conclusions and relevance: These results reinforce prior studies that found increased blood pressure variability is associated with worse neurologic outcome after stroke. These data should help guide research on blood pressure variability after stroke and advocate for the inclusion of death as a clinical outcome in future studies that therapeutically reduce blood pressure variability. SAGE Publications 2019-06-11 /pmc/articles/PMC6560789/ /pubmed/31217966 http://dx.doi.org/10.1177/2048004019856496 Text en © The Author(s) 2019 http://creativecommons.org/licenses/by-nc/4.0/ Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Research Paper de Havenon, Adam Stoddard, Greg Saini, Monica Wong, Ka-Ho Tirschwell, David Bath, Phillip Increased blood pressure variability after acute ischemic stroke increases the risk of death: A secondary analysis of the Virtual International Stroke Trial Archive |
title | Increased blood pressure variability after acute ischemic stroke
increases the risk of death: A secondary analysis of the Virtual International
Stroke Trial Archive |
title_full | Increased blood pressure variability after acute ischemic stroke
increases the risk of death: A secondary analysis of the Virtual International
Stroke Trial Archive |
title_fullStr | Increased blood pressure variability after acute ischemic stroke
increases the risk of death: A secondary analysis of the Virtual International
Stroke Trial Archive |
title_full_unstemmed | Increased blood pressure variability after acute ischemic stroke
increases the risk of death: A secondary analysis of the Virtual International
Stroke Trial Archive |
title_short | Increased blood pressure variability after acute ischemic stroke
increases the risk of death: A secondary analysis of the Virtual International
Stroke Trial Archive |
title_sort | increased blood pressure variability after acute ischemic stroke
increases the risk of death: a secondary analysis of the virtual international
stroke trial archive |
topic | Research Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6560789/ https://www.ncbi.nlm.nih.gov/pubmed/31217966 http://dx.doi.org/10.1177/2048004019856496 |
work_keys_str_mv | AT dehavenonadam increasedbloodpressurevariabilityafteracuteischemicstrokeincreasestheriskofdeathasecondaryanalysisofthevirtualinternationalstroketrialarchive AT stoddardgreg increasedbloodpressurevariabilityafteracuteischemicstrokeincreasestheriskofdeathasecondaryanalysisofthevirtualinternationalstroketrialarchive AT sainimonica increasedbloodpressurevariabilityafteracuteischemicstrokeincreasestheriskofdeathasecondaryanalysisofthevirtualinternationalstroketrialarchive AT wongkaho increasedbloodpressurevariabilityafteracuteischemicstrokeincreasestheriskofdeathasecondaryanalysisofthevirtualinternationalstroketrialarchive AT tirschwelldavid increasedbloodpressurevariabilityafteracuteischemicstrokeincreasestheriskofdeathasecondaryanalysisofthevirtualinternationalstroketrialarchive AT bathphillip increasedbloodpressurevariabilityafteracuteischemicstrokeincreasestheriskofdeathasecondaryanalysisofthevirtualinternationalstroketrialarchive AT increasedbloodpressurevariabilityafteracuteischemicstrokeincreasestheriskofdeathasecondaryanalysisofthevirtualinternationalstroketrialarchive |