Impact of acute blood pressure variability on ischemic stroke outcome

Background: The authors previously reported a low initial emergency department (ED) blood pressure (BP) to be associated with a significantly increased risk of death at 90 days. In this article, they examine the impact of acute BP variability following onset of ischemic stroke. Methods: The study cohort consisted of 71 patients with stroke onset less than 24 hours. BP measurements were obtained every 5 minutes for the duration of the patient's ED stay. During the first 180 minutes, the median number of readings per patient was 9 (range 2 to 30). Results: The baseline median systolic (sBP) and diastolic (dBP) BPs were not different for the patients that died within 90 days compared with those that were alive (p = 0.91 for sBP and p = 0.27 for dBP). Patients who died within 90 days had a greater differential in their dBP during the first 180 minutes than the patients that were alive after 90 days (median 44.5 vs 25 mm Hg; Wilcoxon rank sum test, p < 0.001). A similar result was observed for sBP (median 47 vs 30 mm Hg; p = 0.047). Conclusion: Wide fluctuation of blood pressure in the first 3 hours of the emergency department stay in patients with acute ischemic stroke appears to be associated with an increased risk of death at 90 days.