Background and purpose Blood pressure variability has been found to contribute to worse outcomes after intravenous tissue plasminogen activator, but the association has not been established after intra-arterial therapies.
Methods We retrospectively reviewed patients with an ischemic stroke treated with intra-arterial therapies from 2005 to 2015. Blood pressure variability was measured as standard deviation (SD), coefficient of variation (CV), and successive variation (SV). Ordinal logistic regression models were fitted to the outcome of the modified Rankin Scale (mRS) with univariable predictors of systolic blood pressure variability. Multivariable ordinal logistic regression models were fitted to the outcome of mRS with covariates that showed independent predictive ability (P<0.1).
Results There were 182 patients of mean age 63.2 years and 51.7% were female. The median admission National Institutes of Health Stroke Scalescore was 16 and 47.3% were treated with intravenous tissue plasminogen activator. In a univariable ordinal logistic regression analysis, systolic SD, CV, and SV were all significantly associated with a 1-point increase in the follow-up mRS (OR 2.30–4.38, all P<0.002). After adjusting for potential confounders, systolic SV was the best predictor of a 1-point increase in mRS at follow-up (OR 2.63–3.23, all P<0.007).
Conclusions Increased blood pressure variability as measured by the SD, CV, and SV consistently predict worse neurologic outcomes as measured by follow-up mRS in patients with ischemic stroke treated with intra-arterial therapies. The SV is the strongest and most consistent predictor of worse outcomes at all time intervals.
- blood pressure
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Contributors AEB, GJS, ADH: Substantial contributions to the conception or design of the work, the acquisition, analysis, and interpretation of data for the work. MJW, JJW, JJM, SA: Substantial contributions to the conception or design of the work. JSM: Acquisition, analysis, or interpretation of data for the work. AEB: Drafting the work and revising it critically for important intellectual content. MJW, JSM, JJW, GJS, JJM, SA, ADH: Revising it critically for important intellectual content. AEB, MJW, JSM, JJW, GJS, JJM, SA, ADH: Final approval of the version to be published. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Funding This investigation was supported by the University of Utah CTSA Biostatistical Core through Grant 5UL1TR001067-02 (formerly 8UL1TR000105 and UL1RR025764). Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number KL2TR001065. StrokeNet NIH funding through grant 5U10NS086606-03.
Competing interests None declared.
Ethics approval University of Utah IRB.
Provenance and peer review Not commissioned; externally peer reviewed.