Study links short-term blood pressure variability to Alzheimer's-related brain loss

 

Let's see how long your doctor has been incompetent in not addressing this problem! And the doctor and board of directors haven't been fired yet?

blood pressure variability (7 posts to July 2016)

Study links short-term blood pressure variability to Alzheimer's-related brain loss

Even when blood pressure is well controlled, older adults whose blood pressure fluctuates widely from one heartbeat to the next may be at greater risk for brain shrinkage and nerve cell injury, according to a new study led by the USC Leonard Davis School of Gerontology.

The study, first published online in the Journal of Alzheimer's Disease on October 17, reveals that short-term "dynamic instability" in blood pressure - moment-to-moment changes measured over just minutes - is linked to loss of brain tissue in regions critical for memory and cognition, as well as to blood biomarkers of nerve cell damage.

"Our findings show that even when average blood pressure is normal, instability from one heartbeat to the next may place stress on the brain," said USC Leonard Davis School Professor of Gerontology and Medicine Daniel Nation, senior author of the study. "These moment-to-moment swings appear to be associated with the same kinds of brain changes we see in early neurodegeneration."

Beyond high blood pressure: the importance of stability

While high average blood pressure has long been known to increase the risk of dementia, this study focuses on blood pressure variability, or how much blood pressure rises and falls over short time periods. Recent evidence suggests that such fluctuations can strain small blood vessels in the brain and reduce their ability to deliver steady blood flow.

In this study, the researchers combined two complementary measures:

• Average Real Variability (ARV), which captures how much systolic blood pressure (the top number in a blood pressure reading) changes between each heartbeat.
• Arterial Stiffness Index (ASI), which reflects how flexible or stiff the arteries are as they respond to those changes in pressure.

Together, these measures indicate how much blood flow changes over a short period of time, or what the researchers call "blood pressure dynamic instability."

"Blood pressure isn't static; it's always adapting to the body's needs," Nation explained.

But as we age, that regulation can become less precise. This study suggests that excessive fluctuations could be a sign of vascular aging that contributes to brain injury."

Daniel Nation, Leonard Davis School Professor of Gerontology and Medicine, University of Southern California

Measuring brain and blood changes

The study included 105 community-dwelling older adults between ages 55 and 89 who were generally healthy and had no major neurological disease. During MRI scans, participants' blood pressure was monitored continuously using a finger cuff device that recorded every beat for seven minutes. Researchers then analyzed how these fine-scale fluctuations related to brain structure and blood biomarkers linked to neurodegeneration.

MRI scans revealed that participants with both high ARV and high ASI, which indicates unstable pressure and stiff arteries, had smaller hippocampal and entorhinal cortex volumes. These two brain regions are vital for learning and memory and are among the first affected by Alzheimer's disease. Blood samples showed that the same individuals had higher levels of neurofilament light (NfL), a blood-based marker that rises when nerve cells are damaged.

Importantly, these findings remained significant even after accounting for participants' age, sex, and average blood pressure, suggesting that fluctuations themselves, not just overall pressure, may be a key risk factor.

In addition, the brain changes appeared more pronounced on the left side, consistent with previous research showing that the left hemisphere may be more vulnerable to vascular stress and neurodegenerative diseases such as Alzheimer's. The researchers speculate that differences in blood vessel anatomy or blood flow demands between hemispheres might make the left side more susceptible.

Implications for dementia prevention

The findings open a new window into how cardiovascular changes contribute to cognitive decline and may offer novel prevention strategies.

"Traditionally, we've focused on lowering average blood pressure numbers," said Trevor Lohman, USC research assistant professor of neurology and gerontology and first author of the study. "But this study suggests we should also be looking at how stable blood pressure is from moment to moment. Reducing these fluctuations could help protect the brain, even in people whose average readings look fine."

Future research will explore whether interventions that stabilize blood pressure, such as tailored medication timing, exercise, or stress reduction, can slow brain aging and reduce dementia risk. The authors also note that because this was a cross-sectional study, it cannot prove cause and effect, necessitating larger, long-term studies that closely examine the links between cardiovascular and brain health.

"Our results underscore how closely connected the heart and brain are," Lohman said. "Maintaining steady, healthy blood flow could be one of the best ways to support brain health as we age."

Source:

University of Southern California

Journal reference:

Lohman, T., et al. (2025) Blood pressure dynamic instability and neurodegeneration in older adults. Journal of Alzheimer’s Disease. doi.org/10.1177/13872877251386443.

High blood pressure variability linked to brain atrophy in older adults

 How exactly is your doctor addressing arterial stiffness and neurofilament light chain problems? Oh, has DONE NOTHING, LIKE USUAL!    

Let's see how long your doctor has been incompetent!

blood pressure variability (7 posts to July 2016)

Arterial stiffness (31 posts to December 2014)

Neurofilament light chain (12 posts to January 2019)

High blood pressure variability linked to brain atrophy in older adults

The combination of high beat-to-beat blood pressure variability (BPV) and elevated pulse pressure variability -- a marker of arterial stiffness -- was linked to medial temporal lobe atrophy and increased plasma neurofilament light chain (NfL), both key markers of neurodegeneration, according to a study published in the Journal of Alzheimer’s Disease.

The findings suggest that haemodynamic instability may play a significant role in age-related brain decline, highlighting the importance of monitoring and managing BPV to protect cognitive health.

“Our findings show that even when average blood pressure is normal, instability from one heartbeat to the next may place stress on the brain,” said senior author Daniel A. Nation, PhD, University of Southern California, Los Angeles, California. “These moment-to-moment swings appear to be associated with the same kinds of brain changes we see in early neurodegeneration.”

The researchers recruited 105 older adults without major neurological or systemic diseases to investigate the relationship between BPV and markers of neurodegeneration. Participants underwent continuous blood pressure monitoring to quantify beat-to-beat variability using systolic average real variability (ARV) and pulse pressure variability via an arterial stiffness index (ASI). Brain MRI assessed medial temporal lobe atrophy, while plasma samples measured NfL and glial fibrillary acidic protein (GFAP) as biomarkers of neuronal and glial injury.

Analysis revealed that participants with both high ARV and high ASI exhibited significant left-sided medial temporal lobe atrophy, including in the hippocampus and entorhinal cortex, confirmed through region-of-interest and voxel-based morphometry analyses. This combination was also associated with elevated plasma NfL levels, indicating increased neurodegenerative activity, though GFAP levels were unaffected.

“Traditionally, we’ve focused on lowering average blood pressure numbers,” said Trevor Lohman, PhD, University of Southern California. “But this study suggests we should also be looking at how stable blood pressure is from moment to moment. Reducing these fluctuations could help protect the brain, even in people whose average readings look fine.”

The authors noted that because this was a cross-sectional study, it cannot prove cause and effect, necessitating larger, long-term studies that closely examine the links between cardiovascular and brain health.

Reference: https://journals.sagepub.com/doi/10.1177/13872877251386443

SOURCE: University of Southern California

The Association between Hourly Systolic Blood Pressure Variability and Outcomes in Patients with Intracerebral Hemorrhage is Time-Dependent: Post-hoc Analysis of the ATACH-2 Trial

 So, you described a problem; PROVIDED NO SOLUTION; You're fired!

Because our incompetent stroke medical 'professionals' still haven't figured out an EXACT BLOOD PRESSURE MANAGEMENT PROTOCOL post stroke! And YOU bear the failure of that! Hope your competent? doctor guesses correctly because the poor outcome happens to you! Your doctor gets off scot-free and still gets paid!

• blood pressure management (100 posts to June 2017)

The Association between Hourly Systolic Blood Pressure Variability and Outcomes in Patients with Intracerebral Hemorrhage is Time-Dependent: Post-hoc Analysis of the ATACH-2 Trial

Abstract

Systolic blood pressure (SBP) variability has been associated with an increase in rates of death or disability in patients with intracerebral hemorrhage (ICH). We analyzed data from the Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH)-2 trial to determine whether the association between SBP variability and death or disability at 90 days is dependent on the time from randomization. The difference between maximum and minimum SBP (hourly SBP range) for the first 24 h after enrollment was used to calculate the hourly SBP variability. The effect of hourly SBP variability was evaluated in logistic regression models on: (1) death or disability (modified Rankin scale score of 4–6 at 90 days), (2) hematoma expansion (increase of > 33% in volume on the computed tomography scan obtained at 24 h) within 24 h, (3) neurological deterioration within 24 h, and (4) acute kidney injury within 72 h after enrollment. We adjusted for age, baseline Glasgow Coma Scale score, intraventricular hemorrhage, hematoma volume, and maximum SBP values for each time window. A total of 961 patients (mean age ± standard deviation [SD], 62 ± 13 years; 61.9% were men) who were enrolled at a mean ± SD time of 184 ± 56 min from symptom onset were analyzed. The mean ± SD hourly SBP variability was 15.6 ± 16 mm Hg. The hourly SBP variability became significantly lower with increasing time intervals from randomization (ranging from 41.8 ± 23.3 at hour 1 to 12.4 ± 14.0 at hour 24, P < 0.0001). SBP variability at five hours (P = 0.014) and six hours (P = 0.014) after enrollment was significantly associated with death or disability at 90 days, with positive but not statistically significant associations observed at all other points up to eight hours after randomization. Risk of neurological deterioration within 24 h was highly associated with SBP variability, with the largest association observed between one (P < 0.001) and five (P < 0.001) hours following randomization, with significant associations observed up to 22 h following randomization. Risk of hematoma expansion was associated with SBP variability between three (P = 0.015) and eight (P = 0.002) hours after randomization. Statistically significant associations between SPB variability and risk of acute kidney injury were not observed. Reduced SBP variability within the first eight hours following randomization appears most impactful on both short-term and long-term outcomes in patients with ICH, and the first eight hours may represent a time window for future interventions directed at reducing SBP variability in patients with ICH.

Blood pressure variability: A stronger marker for Alzheimer's risk than heart rate variability

Hopefully your doctor knows this and corrects any blood pressure variability you have.

Your chances of getting dementia.

1. A documented 33% dementia chance post-stroke from an Australian study?   May 2012.

2. Then this study came out and seems to have a range from 17-66%. December 2013.`    

3. A 20% chance in this research.   July 2013.

4. Dementia Risk Doubled in Patients Following Stroke September 2018

The latest here:

Blood pressure variability: A stronger marker for Alzheimer's risk than heart rate variability

By Dr. Priyom Bose, Ph.D.Jan 23 2024

A recent Scientific Reports study assessed whether clinically derived measures of heart rate variability (HRV) and blood pressure variability (BPV) are associated with the manifestation of Alzheimer’s Disease and Related Dementias (ADRD).

Study: Blood pressure variability supersedes heart rate variability as a real-world measure of dementia risk. Image Credit: Andrii Vodolazhskyi / Shutterstock

Background

Previous studies have established a link between cardiovascular measures of autonomic dysfunction and ADRD manifestation. Considering this association, these studies have proposed a method to detect individuals at a higher risk of developing cognitive dysfunction.

A higher BPV is one of the most prominent factors associated with the incidence of ADRD. To obtain BPV data, frequent blood pressure measurements spanning over many years are required. One of the challenges of obtaining BPV data is that most clinical practices do not follow the required high-fidelity protocols to measure blood pressure. Therefore, it is important to evaluate whether the BPV generated using clinical practice data offers similar valuable information regarding ADRD risk prediction.

Therefore, while promising, it remains unclear if BPV derived from clinically generated blood pressure data may offer similar or even any valuable information with respect to ADRD risk stratification in a real-world clinical care setting.

Besides BPV, HRV can also be considered to determine cognitive dysfunction. In contrast to BPV, HRV can be generated using a much shorter period of data. The Multi-Ethnic Study of Atherosclerosis (MESA) study indicated an association between higher HRC and better cognitive performance. Compared to blood pressure assessment, electrocardiogram (EKG) ascertainment is less prone to measurement error. However, compared to the rate of blood pressure assessment, EKG is performed much less frequently.

To prevent ADRD development, it is imperative to develop cost-effective and accurate tools for identifying people at higher risk of ADRD. This strategy will also help identify people who are at an early stage of cognitive dysfunction and offer clinicians more time to design effective treatment plans to delay disease progression.

About the Study

This study assessed the potential of BPV and HRV in predicting the risk of ADRD. All relevant data linked to the clinical assessment period of 2013-2016 was obtained from the electronic health record (EHR) of a large academic medical center in Southern California. 

For the study cohort, the age, sex, smoking status, and ethnicity of the selected participants were obtained. Furthermore, information about the comorbidities of the participants, such as chronic kidney disease, diabetes mellitus, atrial fibrillation or flutter, myocardial infarction, coronary artery disease, heart failure, cancer metastases, and stroke, was collected. 

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Participants with a history of ADRD or less than 18 years of age were excluded from the cohort. From this cohort, patients with HRV were identified based on EKG reports. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) of the selected participants were obtained to estimate BPV.

Study Findings

A total of 48,204 patients fulfilled all eligibility criteria and were considered in this study. Although blood pressure measurements were obtained for all patients, EKG of only 7270 patients were noted. 

The average age of participants in the blood pressure cohort was 54.9 years, and most of this cohort was female. Several comorbidities commonly prevailed in this cohort, namely, diabetes mellitus, heart failure, kidney disease, and coronary artery disease. During the clinical assessment period, each patient had an average of 15.4 blood pressure measurements. Their mean SBP was ~124 mmHg, and DBP was ~73.8 ± 7.2 mmHg. Around 28.1% of the cohort was prescribed with at least one antihypertensive drug.

The average age of the EKG cohort was 68.1 years, and the majority of participants of this cohort were female. The most common comorbid condition identified in the EKG cohort was coronary artery disease, followed by heart failure, diabetes mellitus, and atrial fibrillation/flutter. Participants underwent around 23.9 blood pressure measurements in the clinical assessment period, and average SBP and DBP were estimated to be 11.8 mmHg and 73 mmHg, respectively. In this cohort, 46.1% of participants were prescribed at least one antihypertensive medication.

The current study observed that in comparison to HRV, BPV derived from real-world, i.e., clinically generated data, were robustly associated with the incidence of ADRD across sex and age strata. This finding implies that BPV can be effectively used to identify patients at a higher risk of developing ADRD. Previous studies have indicated that high BPV and low HRV were linked with neurovascular damage, which could lead to cognitive dysfunction.

Conclusions

In contrast to HRV, the clinically derived BPV was found to be a more potent marker of ADRD risk. Therefore, BPV can be used for screening of ADRD risk. However, a better understanding of the dynamic combinations of different risk traits linked with ADRD is needed over the life course. This information could help develop a better strategy for ADRD management.

Journal reference:

• Ebinger, J. E. et al. (2024) Blood pressure variability supersedes heart rate variability as a real-world measure of dementia risk. Scientific Reports, 14(1), 1-11. DOI: 10.1038/s41598-024-52406-8, https://www.nature.com/articles/s41598-024-52406-8

Increased variability of mean arterial pressure is associated with increased risk of short-term mortality in intensive care unit: A retrospective study

For stroke patients, what is the protocol that will prevent this increased mortality? Your hospital probably should have been working on solving this problem for decades.

Increased variability of mean arterial pressure is associated with increased risk of short-term mortality in intensive care unit: A retrospective study

Jia Yao^1†, Dandan Liu^1†, Weifeng Huang², Yuexin Fang¹, Yifan Yang¹, Yingchuan Li², Pengyuan Liu^3* and Xiaoqing Pan^1*

• ¹Department of Mathematics, Shanghai Normal University, Shanghai, China
• ²Department of Critical Care Medicine, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China
• ³Department of Respiratory Medicine, Sir Run Run Shaw Hospital and Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou, China

Background: In intensive care unit (ICU), what thresholds of MAP variability are effective in distinguishing low- and high-risk patients for short-term mortality (in-hospital and 28-day) remains unclear.

Methods: Fifteen thousand five hundred sixty adult subjects admitted to ICU at Beth Israel Deaconess Medical Center (Boston, USA) between 2001 and 2012 were included in this retrospective study from MIMIC-III database. MAP within the first 24 h after admission were collected. Quantiles of MAP variability from 10% to 90% with 10% increasement each were considered to divide study participants into two groups, either having coefficients of variation of MAP greater or less than the given threshold. The threshold of MAP variability was identified by maximizing the odds ratio associated with increased risk of short-term mortality (in-hospital and 28-day). Logistic regression and Cox regression models were further applied to evaluate the association between increased variability of MAP and short-term mortality (in-hospital and 28-day).

Results: 90% quantile of MAP variability was determined as the threshold generating the largest odds ratio associated with the increased risk of short-term mortality. Increased MAP variability, especially over 90% of MAP variability, was associated with increased risk of in-hospital mortality (odds ratio: 2.351, 95% CI: 2.064–2.673), and 28-day mortality (hazard ratio: 2.064, 95% CI: 1.820–2.337).

Conclusion: Increased MAP variability, especially over 90% of MAP variability, is associated with short-term mortality. Our proposed threshold of MAP variability may aid in the early identification of critically ill patients with a high risk of mortality.

Introduction

Blood pressure (BP) is a fundamental physiological variable monitored in intensive care medicine. The variation of BP arises naturally because BP is influenced by biological, behavioral, emotional, and environmental factors and their complex interactions (1–5). The increased variation of BP has been reported to be associated with various organ injuries, high risks of cardiovascular and cerebrovascular events, and mortality, as it reflects sympathetic activation and impairment of baroceptive reflexes (6–9).

BP variation is a continuous phenotype, mainly divided into short-term (minutes to hours) and long-term (days and months) variation. Both short- and long-term blood pressure variability independently increased the risk of death in hypertensive patients as well as in patients with diabetes and chronic kidney disease (10–12). Critically ill patients are often accompanied by high incidence of anxiety, delirium, sleep deprivation, central, and autonomic dysregulation during intensive care unit (ICU) (13), which may contribute to increased BP variation, especially short-term BP variation. Increased short-term BP variability is known to adversely affect patients with chronic diseases, however the extent to which increased short-term BP variability increases the risk of in-hospital mortality in critically ill patients in the ICU remains to be further investigated.

Circadian rhythm of mean arterial pressure (MAP) is recommended for assessing the prognosis of patients admitted to ICU in the clinical setting (14, 15). Although accumulating evidence also indicated that increased BP variability was independently associated with higher risk of target-organ damage, cardiovascular event, and mortality (11, 13, 16–18), little was known about the threshold at which MAP variability is high enough to have clinical significance in critically ill patients. In this study, we hypothesized that increased MAP variability is associated with short-term mortality and further proposed a threshold of MAP variability to aid early identification of critically ill patients at a high risk of mortality.

More at link.

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.

 

 

Time-dependent shift of the relationship between systolic blood pressure and clinical outcome in acute lacunar stroke

 What the fuck does knowing this help stroke recovery to 100% recovery?

Time-dependent shift of the relationship between systolic blood pressure and clinical outcome in acute lacunar stroke

 

Show all authors

Dong W Shin, Philip B Gorelick, Hee-Joon Bae, ...

First Published April 7, 2021 Research Article Find in PubMed 

https://doi.org/10.1177/17474930211006243

Article information

 

Abstract

Background and aims

This study explores the relationship between systolic blood pressure during the acute period of stroke and poor functional outcome in patients with lacunar stroke, emphasizing a possible time-dependent nature of the relationship.

Methods

Based on multicenter stroke registry data, patients with acute lacunar stroke were identified, and systolic blood pressure levels at eight time points (1, 2, 4, 8, 16, 24, 48, and 72 h) after stroke onset were extracted at the 15 participating centers in South Korea. Poor functional outcome was defined as a three-month modified Rankin Scale score of 2–6. Non-linear restricted cubic spline and linear models were used for assessing the relationship at each time point.

Results

A total of 97,349 systolic blood pressure measurements of 3,042 patients were analyzed. At 1 h and 4 h after stroke onset, the relationship between systolic blood pressure and poor outcome showed a non-linear association. The nadir was 155 mmHg at 1 h and 124 mmHg at 4 h. After this time period, a higher systolic blood pressure was associated with a poorer outcome. This linear relationship weakened over time after 12 h (coefficient values of the adjusted linear models: 0.0081 at 8 h, 0.0105 at 12 h, 0.0102 at 24 h, 0.0082 at 48 h, 0.0054 at 72 h).

Conclusions

Based on our cohort of large number of lacunar stroke patients, our findings suggest that systolic blood pressure levels may follow a time-dependent course in relation to prediction of outcome at three months. The findings may be valuable for hypothesis generation in association with clinical trial development for blood pressure control in acute stroke patients.

Day-by-Day Blood Pressure Variability Is Associated With Neurological Functional Outcome After Acute Ischemic Stroke

 Useless; you described a problem but offered NO SOLUTION. Your mentors and senior researchers need to be fired for not even attempting to solve the only goal in stroke: 100% RECOVERY!

Day-by-Day Blood Pressure Variability Is Associated With Neurological Functional Outcome After Acute Ischemic Stroke

 

Changqiang Yang^1†, Kai Liu^1†, Yue Song², Shenzhen Gong¹, Runyu Ye¹, Zhipeng Zhang¹ and Xiaoping Chen^1*

• ¹West China Hospital, Sichuan University, Chengdu, China
• ²West China Second University Hospital, Sichuan University, Chengdu, China

Background: Increased blood pressure variability (BPV) might be a detrimental factor after acute ischemic stroke. Previous studies on the association between blood pressure variability in the acute ischemic stroke and functional outcome have yielded inconsistent results. We aimed to investigate the impact of day-by-day blood pressure variability within 7 days of onset on functional outcome at 3 months after acute ischemic stroke.

Methods: Total 367 patients hospitalized for ischemic stroke within 48 h of onset were enrolled. The acute stage of ischemic stroke was defined as the time period from symptom onset to 7 days. During this period, blood pressure was measured twice daily (respectively, in the morning during 8:00 a.m.−10:00 a.m., in the afternoon between 15:00 p.m. and 17:00 p.m.). Day-by-day blood pressure variability, including standard deviation (SD) and coefficient variation (CV) were derived and compared to functional outcome. We dichotomized function outcome according to mRS score and unfavorable outcome was defined as mRS ≥3.

Results: The patients with unfavorable outcome had significantly higher systolic BPV (within 7 days of onset) than those with favorable outcome (15.41 ± 4.59 vs. 13.42 ± 3.95 mmHg for SD, P < 0.001; 11.54 ± 3.23 vs. 10.41 ± 2.82 for CV, P = 0.001). Multivariable logistic regression analysis revealed that systolic BPV was significantly and independently associated with the 3-month functional outcome [odds ratio (OR) = 1.15, 95% confidence interval (CI): 1.07–1.22, P < 0.001 for SD; OR = 1.15, 95% CI: 1.06–1.26, P = 0.001 for CV]. In addition, After adjustment for multiple confounding factors, including age, gender, risk factors, stroke features, baseline severity, recanalized therapy, hemorrhagic transformation, pulmonary infection, white blood cell, estimated Glomerular Filtration Rate and mean BP, day-by-day BP variability was significantly correlated with an unfavorable outcome in the top vs. bottom quartile of systolic BPV (OR = 3.33, 95% CI: 1.41–7.85, P = 0.006 for SD; OR = 2.27, 95% CI: 1.04–4.94, P = 0.037 for CV) during 3-month follow-up. Similar trends were also observed for diastolic BPV. More importantly, incorporating SD of systolic BP into the conventional prediction model could significantly increase the AUC for prediction of 3-month unfavorable outcome after acute ischemic stroke (0.84 vs. 0.86; P = 0.0416).

Conclusions: Increased day-by-day blood pressure variability of systolic or diastolic BP in the acute ischemic stroke was associated with higher risk for unfavorable outcome at 3 months independent of blood pressure levels. Combining SD of systolic BP with conventional risk factors could improve the prediction of unfavorable outcome.

Introduction

Hypertension is the most prevalent modifiable risk factor for ischemic stroke and blood pressure reduction is an important goal for stroke risk reduction (1). Optimal blood pressure levels have been well-established for the primary and secondary prevention of ischemic stroke occurrence and recurrence (2). However, the optimal management of blood pressure during the acute stage of ischemic stroke has not been confirmed and remains controversial (3). A series of randomized clinical trials of blood pressure lowering in acute ischemic stroke have been conducted and showed a neutral effect of BP reduction on clinical outcomes (4–8). Recent studies have suggested that the risk of cardiovascular complications may not only depend on the magnitude of blood pressure elevation but also on the presence of increased blood pressure variability, even to a larger extent than average BP values in populations at high cardiovascular risk (9). Therefore, blood pressure variability may be an important predictor of ischemic stroke risk and outcome.

Available evidence about the effect of BPV on outcome after acute ischemic stroke is scarce. Most studies focus on the association between short-term blood pressure variability (BPV) within first 24–72 h after ischemic stroke onset and functional outcome (10–15). Some report that short-term BPV is associated with unfavorable outcome at 3 months after acute ischemic stroke (12–14), whereas others do not find any association (10, 11, 15). A recent systemic review and meta-analysis suggests that this short-term blood pressure variability assessed in the acute stage of ischemic stroke is associated with poor long-term functional outcome (16). However, there are limited data regarding the relationship between mid-term blood pressure variability (day-by-day BPV) and outcome in acute ischemic stroke. The aim of the present study is to investigate whether day-by-day blood pressure variability within 7 days of onset is associated with 3-month functional outcome of patients with acute ischemic stroke.

More at link.

Dementia risk with antihypertensive use and blood pressure variability

Ask your doctor what the hell this means for the blood pressure drugs you are taking. I don't understand.

Dementia risk with antihypertensive use and blood pressure variability

1. Phillip J. Tully, MPsych(Clin), PhD,
2. Jean-François Dartigues, MD, PhD,
3. Stephanie Debette, MD, PhD,
4. Catherine Helmer, PhD,
5. Sylvaine Artero, PhD and
6. Christophe Tzourio, MD, PhD

+Show Affiliations

| + Show Full Disclosures

1. Correspondence to Dr. Tzourio: christophe.tzourio@u-bordeaux.fr

1. Published online before print July 8, 2016, doi: http:/​/​dx.​doi.​org/​10.​1212/​WNL.​0000000000002946 Neurology 10.1212/WNL.0000000000002946

• Abstract
• Full Text (PDF)

1. Also available:
2. Data Supplement

Abstract

Objective: To determine the association between discrete antihypertensive drug classes and incident dementia controlling for blood pressure variability (BPV) in the preceding 4 years.

Methods: A total of 6,537 participants (mean age 79 years, 62% women) in a prospective population-based cohort were followed up for incident dementia. A 4-year time lag period was created to classify drug exposure and measure blood pressure. BPV (percent coefficient of variation [CV]) was regressed against 9 antihypertensive drug classes (BPV_reg). Cox regression models were employed to determine hazard ratios (HRs) for incident dementia thereafter according to drug class, adjusted for mean blood pressure, covariates, and BPV or BPV_reg.

Results: Over a median 8.4 years follow-up (interquartile range 6.7–9.0), lower dementia risk was associated with nondihydropyridine calcium channel blocker (HR 0.56; 95% confidence interval [CI] 0.31–1.00, p = 0.05) and loop diuretics (HR 0.45; 95% CI 0.22–0.93, p = 0.03) after adjusting for CV-BPV. Similar findings were obtained in analyses restricted to antihypertensive drug users for nondihydropyridine calcium channel blocker (HR 0.52; 95% CI 0.28–0.95, p = 0.03) and loop diuretics (HR 0.40; 95% CI 0.19–0.83, p = 0.01). All systolic BPV × antihypertensive drug interaction terms were not different from p < 0.05.

Conclusions: Nondihydropyridine calcium channel blocker and loop diuretics were associated with a reduced dementia risk independent of CV-BPV in the preceding 4 years. Systolic BPV was not the primary mechanism through which antihypertensive drug classes lower dementia risk.

• Received November 18, 2015.
• Accepted in final form April 27, 2016.

• © 2016 American Academy of Neurology