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Blood pressure variability and the development of early neurological deterioration following acute ischemic stroke

Chung, Jong-Wona,*; Kim, Nayoungb,*; Kang, Jihoonc; Park, Su Hyund; Kim, Wook-Jooe; Ko, Youngchaif; Park, Jung Hyung; Lee, Ji Sungh; Lee, Juneyoungi; Yang, Mi Hwaj; Jang, Myung Sukj; Oh, Chang Wank; Kwon, O-Kik; Jung, CheolKyul; Kim, Beom Joonj; Han, Moon-Kuj; Gorelick, Philip B.m,n; Bae, Hee-Joonj

doi: 10.1097/HJH.0000000000000675

Objectives: Early neurological deterioration (END) is a common condition associated with poor outcome after acute ischemic stroke. We studied association between blood pressure (BP) variability and development of END.

Methods: In this retrospective observational study, we studied a consecutive series of patients hospitalized for acute ischemic stroke within 24 h of onset. The primary outcome of interest was the development of END according to predefined criteria within the first 72 h of stroke onset. During this period, the mean, maximum (max), and minimum (min) values for the SBP and DBP were measured. The following parameters of BP variability were calculated for the SBP and DBP: the difference between the maximum and minimum (max−min), the SD, and the coefficient of variation.

Results: Of the 1161 patients enrolled in the study (mean age, 67.5 ± 13.3 years; 59.6% men), 210 (18.1%) developed END. All of the BP variability parameters were linearly associated with END independent of mean BP and potential clinical variables (P values < 0.05 on likelihood ratio tests for trend), except for SBPmax−min. Among the other BP parameters, SBPmean, SBPmax, DBPmax, and DBPmin were independently associated with END. After adjustments for potential confounders, the odds for END increased 14–21% with each increase of one standard deviation in the BP variability parameter.

Conclusion: BP variability is independently and linearly associated with the development of neurologic deterioration in acute stage of ischemic stroke.

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aDepartment of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul

bDepartment of Neurology, Youngdong Hospital, Chungbuk

cDepartment of Neurology, Samsung Changwon Hospital, Sungkyunkwan University, Changwon

dDepartment of Neurology, Pohang St. Mary's Hospital, Pohanga

eDepartment of Neurology, University of Ulsan College of Medicine, Ulsan

fDepartment of Neurology, Eulji University Hospital, Eulji University, Daejeon

gDepartment of Neurology, Ewha Womans University Medical Center

hClinical Research Center, Asan Medical Center

iDepartment of Biostatistics, Korea University College of Medicine, Seoul

jDepartment of Neurology

kDepartment of Neurosurgery

lDepartment of Radiology, Stroke Center, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seongnam, Korea

mDepartment of Translational Science and Molecular Medicine, College of Human Medicine, Michigan State University

nMercy Health Hauenstein Neurosciences, Grand Rapids, Michigan, USA.

*Drs Jong-Won Chung and Nayoung Kim contributed equally to the writing of this article.

Correspondence to Hee-Joon Bae, MD, PhD, Department of Neurology, Stroke Center, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, 300, Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, Korea. Tel: +82 31 787 7467; fax: +82 31 787 4059; e-mail:

Abbreviations: BP, blood pressure; CI, confidence interval; CT, computed tomography; EMR, electronic medical record; END, early neurological deterioration; max, maximum; max−min, difference between maximum and minimum BP; min, minimum; NIHSS, National Institutes of Health Stroke Scale; OR, odds ratio; TIA, transient ischemic attack

Received 19 January, 2015

Revised 20 May, 2015

Accepted 20 May, 2015

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