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Blood pressure variability and outcome in atherosclerosis versus cardioembolism cerebral large vessel occlusion after successful thrombectomy

Hypertension Research volume 47, pages 898–909 (2024)Cite this article

Abstract

Higher blood pressure variability (BPV) has been proven associated with worse functional outcome after endovascular treatment (EVT). However, this association is not established according to different stroke etiologies. In this study, we compared patients with the two highest proportions of stroke etiologies—cardioembolism (CE) and large-artery atherosclerosis (LAA), aiming to explore appropriate strategies of BP management for different etiologies. We enrolled patients with large vessel occlusion (LVO) in anterior circulation who underwent EVT and achieved successful recanalization retrospectively. 24-h blood pressure (BP) and BPV measured as blood pressure reduction (BPr), standard deviation (SD), coefficient of variation (CV), successive variation (SV), average real variability (ARV) after EVT were collected for systolic blood pressure (SBP) and diastolic blood pressure (DBP). The favorable outcome was defined as functional independence by 90-day modified Rankin Scale (mRS 0–2). In our cohort, higher BPV parameters significantly resulted in 90d functional dependence in CE-LVO patients (SBPSV OR: 1.083, 95%CI = 1.009–1.163; SBPARV OR: 1.121, 95%CI = 1.019–1.233; DBPSD OR: 1.124, 95%CI = 1.007–1.1256; DBPCV OR: 1.078, 95%CI = 1.002–1.161). However, for LAA-LVO patients, no positive results correlated 90d functional dependence with 24-hour BPV. Additionally, 90d functional dependence in CE patients with poor collaterals were significantly dependent on post-procedural BPV (DBPmax OR: 1.044, 95%CI = 1.002–1.087; DBPSD OR: 1.229, 95%CI = 1.022–1.1.479; DBPCV OR: 1.143, 95%CI = 1.009–1.295). Whereas to patients with good collaterals, there did not exist such a correlation. In summary, stroke etiologies should probably be taken into consideration to optimize individualized BP management strategies.

In order to achieve better clinical outcomes for patients with acute ischemic stroke due to large vessel occlusion, stricter blood pressure management should be taken in cardioembolic stroke patients in contrast with large artery atherosclerotic stroke patients after successful endovascular therapy.

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Funding

This study was supported by the Natural Science Research Project of the Universities of Anhui Educational Committee (2023AH040256, 2022AH040180, KJ2021A0843), the Scientific Research Fund Project for Talent Introduction of Yijishan Hospital, Wannan Medical College (No. YR202210), the Clinical Medical Research Translational Project (202204295107020017), Anhui Provincial Health Backbone Talent Training Target Project and Anhui Province University Excellent Top Talent Cultivation Project.

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  1. These authors contributed equally: Hao Wang, Yapeng Guo.

Authors and Affiliations

  1. Department of Neurology, The First Affiliated Hospital, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui Province, China

    Hao Wang, Yapeng Guo, Junfeng Xu, Yi Sun, Yachen Ji, Xiangjun Xu, Qian Yang, Xianjun Huang & Zhiming Zhou

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Contributions

HW, YG, XH, and ZZ contributed to the study concept and design. HW and YG contributed to the draft the manuscript. YJ and XX contributed to the acquisition and analysis of the data. JX and YS contributed to image review. QY contributed to revise the manuscript. XH and ZZ are responsible for the overall content as guarantors.

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Correspondence to Xianjun Huang or Zhiming Zhou.

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Wang, H., Guo, Y., Xu, J. et al. Blood pressure variability and outcome in atherosclerosis versus cardioembolism cerebral large vessel occlusion after successful thrombectomy. Hypertens Res 47, 898–909 (2024). https://doi.org/10.1038/s41440-023-01500-x

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