Rapid Assessment of Blood Pressure Variability and Outcome After Successful Thrombectomy

 So you described a problem and yet did nothing to solve it. Useless.

When the hell are we going to get a  blood pressure protocol? While you dither stroke survivors continue to get disabled due to your lack of protocols.  Isn't it your job to deliver stroke recovery protocols?

What we need is an EFFECTIVE STROKE LEADER THAT WILL SOLVE THIS PROBLEM. Alas we have none.

 

• blood pressure variability (3 posts to July 2016)

• blood pressure management (25 posts to June 2017)

•  And much earlier than that: One of the oldest questions in acute stroke management, and perhaps the most challenging since it has yet to be solved after more than half a century of published research, is how to manage high blood pressure (BP).

Rapid Assessment of Blood Pressure Variability and Outcome After Successful Thrombectomy

Pedro Castro

,

Francisca Ferreira

,

Cindy K. Nguyen

,

Seyedmehdi Payabvash

,

Can Ozan Tan

,

Farzaneh Sorond

,

Elsa Azevedo

,

Nils Petersen

Originally published27 Jul 2021https://doi.org/10.1161/STROKEAHA.121.034291Stroke. 2021;52:e531–e535

Abstract

Background and Purpose:

High blood pressure (BP) variability after endovascular stroke therapy is associated with poor outcome. Conventional BP variability measures require long recordings, limiting their utility as a risk assessment tool to guide clinical decision-making. Here, we performed rapid assessment of BP variability by spectral analysis and evaluated its association with early clinical improvement and long-term functional outcomes.

Methods:

We conducted a prospective study of 146 patients with anterior circulation ischemic stroke who underwent successful endovascular stroke therapy. Spectral analysis of 5-minute recordings of beat-to-beat BP was used to quantify BP variability. Outcomes included initial clinical response and modified Rankin Scale at 90 days.

Results:

Increased BP variability at high frequencies was independently associated with poor functional outcome at 90 days (adjusted odds ratio [aOR], 1.85 [95% CI, 1.07–3.25], P=0.03; low-/high-frequency ratio aOR, 0.67 [95% CI, 0.46–0.92], P=0.02) and reduced likelihood of an early neurological recovery (aOR, 0.62 [95% CI, 0.44–0.91], P=0.01 and aOR, 1.37 [95% CI, 1.03–1.87], P=0.04, respectively).

Conclusions:

High-frequency BP oscillations after successful reperfusion may be harmful and associate with a decreased likelihood of neurological recovery and favorable functional outcomes. Rapid assessment of BP variability throughout the postreperfusion period is feasible and may allow for a more personalized BP management.

There is an increased risk of hemorrhagic transformation and worse outcome in patients with increased blood pressure (BP) during the first hours after endovascular stroke therapy (EVT).^1,2 Because of impaired cerebral autoregulation with resulting susceptibility to cerebral hypoperfusion or hyperperfusion,³ avoiding large BP swings after revascularization may be as important as treating high BP levels. Conventional measures of BP variability usually require 24 hours of BP monitoring, limiting their usefulness for clinical decisions making. This study aimed to assess BP variability from 5-minute beat-to-beat recordings using spectral analysis and evaluate its ability to predict early neurological recovery and long-term functional outcome.

More at link.