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Long-term blood pressure variability strongly predicts stroke recurrence

07 Oct 2017

Long-term blood pressure variability (BPV) is more reliable than short-term BPV in predicting stroke recurrence after acute ischaemic stroke or transient ischaemic attack (TIA), a study has shown.

The present investigation included 1,764 patients (mean age 62.45 years; 32.1 percent female; mean body mass index, 24.84 kg m−2) who participated in the BOSS (blood pressure and clinical outcome in transient ischaemic attack [TIA] or ischaemic stroke) study. All patients were examined within 7 days after onset of acute ischemic stroke or TIA.

Short-term BPV was measured using 24-hour ambulatory blood pressure measurement (ABPM) during hospitalization. On the other hand, long-term BPV was determined on the basis of home blood pressure measurement (HBPM), which was taken twice daily by patients or their families from discharge to 90 days after onset of qualifying events. Variability for systolic blood pressure (SBP) was assessed as the SD and coefficients of variance (CV). The clinical outcome was recurrent stroke within 1 year.

During 1-year follow-up, stroke recurrence was reported in 106 (6 percent) patients. Recurrent stroke was significantly associated with indices of long-term BPV (SD: adjusted hazard ratio [aHR], 1.939; 95 percent CI, 1.122 to 3.351; CV: aHR, 1.955; 1.174 to 3.255), independent of mean SBP.

On the other hand, all indices of short-term BPV did not predict stroke recurrence (SD: aHR, 1.245; 0.680 to 2.280; CV: aHR, 1.142; 0.640 to 2.038).

The present data demonstrate that long-term BPV of HBPM is a stronger predictor of stroke recurrence than BPV of ABPM, researchers said.

“Therefore, performing antihypertensive treatment in secondary prevention among patients with ischaemic stroke or TIA further emphasizes the importance of not only achieving but also maintaining stable BP control in the long term,” they added.

Additional prospective studies are needed to investigate how best to measure ABPM in acute ischaemic stroke or TIA, as well as to determine the prognostic significance of measuring ABPM on stroke recurrence.

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Most Read Articles
12 Aug 2019
Treatment with nebivolol yields more favourable changes in 24-hour, intradialytic and daytime systolic and diastolic blood pressure variability in patients with intradialytic hypertension, a study has found.
Stephen Padilla, 25 Jul 2019
Nonvitamin K antagonist oral anticoagulants (NOACs) appear to confer more clinical benefits to elderly patients with atrial fibrillation (AF) than vitamin K antagonist anticoagulants (VKAs), suggests a study, adding that this is primarily driven by the lower rates of major bleeding.
11 Aug 2019
Intraoperative methylprednisolone does not appear to significantly prevent the incidence of death, cardiac arrest and other injuries in neonates undergoing cardiac surgery with cardiopulmonary bypass, according to a recent study.
25 Jul 2019
Adding a third drug to achieve the target blood pressure (BP) seems to be more effective than increasing the dose of existing dual therapy without any increase in adverse events, suggest the results of a meta-analysis, adding that early use of triple therapy can help improve hypertension control.