Blood pressure variability in acute stroke: Risk factors and association with functional outcomes at 1 month

Catriona Reddin; Robert Murphy; Graeme J Hankey; Xingyu Wang; Peter Langhorne; Shahram Oveisgharan; Denis Xavier; Conor Judge; Annika Rosengren; Helle K Iversen; Anna Czlonkowska; Fernando Lanas; Aytekin Oguz; Danuta Ryglewicz; Mohammad Wasay; Andrew Smyth; Salim Yusuf; Martin O'Donnell; INTERSTROKE investigators

doi:10.1111/ene.16314

Blood pressure variability in acute stroke: Risk factors and association with functional outcomes at 1 month

Eur J Neurol. 2024 May 13:e16314. doi: 10.1111/ene.16314. Online ahead of print.

Authors

Catriona Reddin^{1

2}, Robert Murphy¹, Graeme J Hankey^{3

4}, Xingyu Wang⁵, Peter Langhorne⁶, Shahram Oveisgharan⁷, Denis Xavier^{8

9}, Conor Judge¹, Annika Rosengren¹⁰, Helle K Iversen¹¹, Anna Czlonkowska¹², Fernando Lanas¹³, Aytekin Oguz^{14

15}, Danuta Ryglewicz¹⁶, Mohammad Wasay¹⁷, Andrew Smyth¹, Salim Yusuf¹⁸, Martin O'Donnell^{1

18}; INTERSTROKE investigators

Affiliations

¹ HRB Clinical Research Facility Galway, School of Medicine, University of Galway, Galway, Ireland.
² Wellcome Trust-HRB, Irish Clinical Academic Training, Dublin, Ireland.
³ Perron Institute Chair in Stroke Research, Medical School, University of Western Australia, Perth, Western Australia, Australia.
⁴ Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia.
⁵ Beijing Hypertension League Institute, Beijing, China.
⁶ Academic Section of Geriatric Medicine, Glasgow Royal Infirmary, University of Glasgow, Glasgow, UK.
⁷ Rush Alzheimer Disease Research Center, Rush University Medical Center, Chicago, Illinois, USA.
⁸ St Johns Medical College, Bangalore, India.
⁹ St Johns Research Institute, Bangalore, India.
¹⁰ Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
¹¹ Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
¹² Institute of Psychiatry and Neurology, Warsaw, Poland.
¹³ Faculty of Medicine, Universidad de La Frontera, Temuco, Chile.
¹⁴ Department of Internal Medicine, Faculty of Medicine, Istanbul Medeniyet University, Dumlupinar Mahallesi, Istanbul, Turkey.
¹⁵ Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey.
¹⁶ Military Institute of Aviation Medicine, Warszawa, Poland.
¹⁷ Department of Medicine, Aga Khan University, Karachi, Pakistan.
¹⁸ Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada.

PMID: 38738545
DOI: 10.1111/ene.16314

Abstract

Background and purpose: Blood pressure variability, in acute stroke, may be an important modifiable determinant of functional outcome after stroke. In a large international cohort of participants with acute stroke, it was sought to determine the association of blood pressure variability (in the early period of admission) and functional outcomes, and to explore risk factors for increased blood pressure variability.

Patients and methods: INTERSTROKE is an international case-control study of risk factors for first acute stroke. Blood pressure was recorded at the time of admission, the morning after admission and the time of interview in cases (median time from admission 36.7 h). Multivariable ordinal regression analysis was employed to determine the association of blood pressure variability (standard deviation [SD] and coefficient of variance) with modified Rankin score at 1-month follow-up, and logistic regression was used to identify risk factors for blood pressure variability.

Results: Amongst 13,206 participants, the mean age was 62.19 ± 13.58 years. When measured by SD, both systolic blood pressure variability (odds ratio 1.13; 95% confidence interval 1.03-1.24 for SD ≥20 mmHg) and diastolic blood pressure variability (odds ratio 1.15; 95% confidence interval 1.04-1.26 for SD ≥10 mmHg) were associated with a significant increase in the odds of poor functional outcome. The highest coefficient of variance category was not associated with a significant increase in risk of higher modified Rankin score at 1 month. Increasing age, female sex, high body mass index, history of hypertension, alcohol use, and high urinary potassium and low urinary sodium excretion were associated with increased blood pressure variability.

Conclusion: Increased blood pressure variability in acute stroke, measured by SD, is associated with an increased risk of poor functional outcome at 1 month. Potentially modifiable risk factors for increased blood pressure variability include low urinary sodium excretion.

Keywords: blood pressure; blood pressure variability; functional outcomes; sodium; stroke.

Grants and funding

CAPMC/ CIHR/Canada