Reciprocal Interaction of 24-Hour Blood Pressure Variability and Systolic Blood Pressure on Outcome in Stroke Thrombolysis

Lars Kellert, Christian Hametner, Niaz Ahmed, Geraldine Rauch, Mary J MacLeod, Francesco Perini, Kennedy R Lees, Peter A Ringleb

Research output: Contribution to journalArticle

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Abstract

Background and purpose: Significance and management of blood pressure (BP) changes in acute stroke care are unclear. Here we aimed to investigate the impact of 24h-BP-variability (BPV) on outcome in patients with acute ischemic stroke treated with intravenous thrombolysis.

Methods: From the SITS International Stroke Thrombolysis registry 28976 patients with documented pretreatment systolic BP (BPsys), at 2 hours and 24 hours were analyzed. The primary measure of BP variability was successive variability (BPVSV). Data were pre-processed using coarsened exact matching. We assessed early neurological improvement (ENI), symptomatic intracerebral hemorrhage (SICH) and long-term functional outcome [modified Rankin Scale (mRS) at 90 days] by binary and ordinal regression analysis.

Results: Attempts to explain BPVSV with patients’ characteristics at admission found BPsys (5.5% variance) to be most influential, yet 92% of BPV variance remained unexplained. Independently from BPsys, BPVSV was associated with poor functional outcome mRS 0—2 (OR 0.94, 95% CI 0.90-0.98), disadvantage across the shift of mRS (OR 1.04, 95% CI 1.01-1.08), mortality (OR 1.10, 95% CI 1.01-1.08), SICHSITS (OR 1.14, 95% CI 1.06-1.23), and SICHECASS (OR 1.24, 95% CI 1.10-1.40). Analyzing BPVSV as a function of pretreatment BPsys significantly improved the prediction of functional outcome (mRS 0—1, mRS 0–2, ENI, mRS-shift: all PInteraction<0.01). Excluding patients with atrial fibrillation in a sensitivity analysis gave consistent results overall.

Conclusions: This study suggests the need for a more individual blood pressure management accounting for pretreatment BP and the acute BP course (i.e. BPV) to achieve best possible outcome for the patient.

Original languageEnglish
Pages (from-to)1827-1834
Number of pages8
JournalStroke
Volume48
Issue number7
Early online date25 May 2017
DOIs
Publication statusPublished - 2017

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Stroke
Blood Pressure
4-Acetamido-4'-isothiocyanatostilbene-2,2'-disulfonic Acid
Cerebral Hemorrhage
Atrial Fibrillation
Registries
Regression Analysis
Mortality

Keywords

  • atrial fibrillation
  • blood pressure
  • blood pressure variability
  • cerebral hemorrhage
  • regression analysis
  • stroke
  • thrombolysis

Cite this

Reciprocal Interaction of 24-Hour Blood Pressure Variability and Systolic Blood Pressure on Outcome in Stroke Thrombolysis. / Kellert, Lars; Hametner, Christian; Ahmed, Niaz; Rauch, Geraldine; MacLeod, Mary J; Perini, Francesco; Lees, Kennedy R; Ringleb, Peter A.

In: Stroke, Vol. 48, No. 7, 2017, p. 1827-1834.

Research output: Contribution to journalArticle

Kellert, Lars ; Hametner, Christian ; Ahmed, Niaz ; Rauch, Geraldine ; MacLeod, Mary J ; Perini, Francesco ; Lees, Kennedy R ; Ringleb, Peter A. / Reciprocal Interaction of 24-Hour Blood Pressure Variability and Systolic Blood Pressure on Outcome in Stroke Thrombolysis. In: Stroke. 2017 ; Vol. 48, No. 7. pp. 1827-1834.
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T1 - Reciprocal Interaction of 24-Hour Blood Pressure Variability and Systolic Blood Pressure on Outcome in Stroke Thrombolysis

AU - Kellert, Lars

AU - Hametner, Christian

AU - Ahmed, Niaz

AU - Rauch, Geraldine

AU - MacLeod, Mary J

AU - Perini, Francesco

AU - Lees, Kennedy R

AU - Ringleb, Peter A

N1 - © 2017 American Heart Association, Inc.

PY - 2017

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N2 - Background and purpose: Significance and management of blood pressure (BP) changes in acute stroke care are unclear. Here we aimed to investigate the impact of 24h-BP-variability (BPV) on outcome in patients with acute ischemic stroke treated with intravenous thrombolysis. Methods: From the SITS International Stroke Thrombolysis registry 28976 patients with documented pretreatment systolic BP (BPsys), at 2 hours and 24 hours were analyzed. The primary measure of BP variability was successive variability (BPVSV). Data were pre-processed using coarsened exact matching. We assessed early neurological improvement (ENI), symptomatic intracerebral hemorrhage (SICH) and long-term functional outcome [modified Rankin Scale (mRS) at 90 days] by binary and ordinal regression analysis.Results: Attempts to explain BPVSV with patients’ characteristics at admission found BPsys (5.5% variance) to be most influential, yet 92% of BPV variance remained unexplained. Independently from BPsys, BPVSV was associated with poor functional outcome mRS 0—2 (OR 0.94, 95% CI 0.90-0.98), disadvantage across the shift of mRS (OR 1.04, 95% CI 1.01-1.08), mortality (OR 1.10, 95% CI 1.01-1.08), SICHSITS (OR 1.14, 95% CI 1.06-1.23), and SICHECASS (OR 1.24, 95% CI 1.10-1.40). Analyzing BPVSV as a function of pretreatment BPsys significantly improved the prediction of functional outcome (mRS 0—1, mRS 0–2, ENI, mRS-shift: all PInteraction<0.01). Excluding patients with atrial fibrillation in a sensitivity analysis gave consistent results overall.Conclusions: This study suggests the need for a more individual blood pressure management accounting for pretreatment BP and the acute BP course (i.e. BPV) to achieve best possible outcome for the patient.

AB - Background and purpose: Significance and management of blood pressure (BP) changes in acute stroke care are unclear. Here we aimed to investigate the impact of 24h-BP-variability (BPV) on outcome in patients with acute ischemic stroke treated with intravenous thrombolysis. Methods: From the SITS International Stroke Thrombolysis registry 28976 patients with documented pretreatment systolic BP (BPsys), at 2 hours and 24 hours were analyzed. The primary measure of BP variability was successive variability (BPVSV). Data were pre-processed using coarsened exact matching. We assessed early neurological improvement (ENI), symptomatic intracerebral hemorrhage (SICH) and long-term functional outcome [modified Rankin Scale (mRS) at 90 days] by binary and ordinal regression analysis.Results: Attempts to explain BPVSV with patients’ characteristics at admission found BPsys (5.5% variance) to be most influential, yet 92% of BPV variance remained unexplained. Independently from BPsys, BPVSV was associated with poor functional outcome mRS 0—2 (OR 0.94, 95% CI 0.90-0.98), disadvantage across the shift of mRS (OR 1.04, 95% CI 1.01-1.08), mortality (OR 1.10, 95% CI 1.01-1.08), SICHSITS (OR 1.14, 95% CI 1.06-1.23), and SICHECASS (OR 1.24, 95% CI 1.10-1.40). Analyzing BPVSV as a function of pretreatment BPsys significantly improved the prediction of functional outcome (mRS 0—1, mRS 0–2, ENI, mRS-shift: all PInteraction<0.01). Excluding patients with atrial fibrillation in a sensitivity analysis gave consistent results overall.Conclusions: This study suggests the need for a more individual blood pressure management accounting for pretreatment BP and the acute BP course (i.e. BPV) to achieve best possible outcome for the patient.

KW - atrial fibrillation

KW - blood pressure

KW - blood pressure variability

KW - cerebral hemorrhage

KW - regression analysis

KW - stroke

KW - thrombolysis

U2 - 10.1161/STROKEAHA.117.016876

DO - 10.1161/STROKEAHA.117.016876

M3 - Article

C2 - 28546325

VL - 48

SP - 1827

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JO - Stroke

JF - Stroke

SN - 0039-2499

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