Objective: Mean arterial pressure (MAP) is a significant hemodynamic parameter of blood pressure, which is critical for brain tissue damage among patients with ischemic stroke. However, the association of MAP variability during hospitalization with death and cardiovascular events after ischemic stroke remains unclear. Design and method: The present study included 3975 ischemic stroke patients from the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS). After recruitment, 3 blood pressure measurements were obtained every 2 hours for the first 24 hours, every 4 hours during the second and third days, and every 8 hours the fourth day thereafter until the fourteenth day after stroke or hospital discharge. MAP variability during hospitalization was reflected by standard deviation of MAP (MAP-SD), and the difference between the maximum and minimum values of the MAP (MAP-DMM) during hospitalization. The outcome of the present study was a composite outcome of death or cardiovascular events within 3 months after ischemic stroke. Results: After multivariate adjustment, the largest MAP-SD during hospitalization (odds ratio: 1.78, 95% CI:1.14-2.79, P trend <0.001), and the largest MAP-DMM during hospitalization (odds ratio: 1.69, 95% CI: 1.09-2.62, P trend=0.011) were associated with an increased risk of composite outcome of death or cardiovascular events when 2 extreme quartiles were compared. Adding MAP variability during hospitalization to conventional risk factors significantly improved predictive power for composite outcome of death or cardiovascular events (MAP-SD: NRI= 18.41%, 95% CI:2.86%-33.51%, P=0.022. IDI= 0.11%, 95% CI:0.01%-0.24%, P= 0.057. MAP-DMM: NRI= 18.42%, 95% CI:3.12%-33.71%, P=0.020. IDI= 0.12%, 95% CI:0.01%-0.23%, P=0.033). Conclusions: The largest MAP variability during hospitalization were associated with increased risk of composite outcome of death or cardiovascular events within 3 months after ischemic stroke.
Xu et al. (Fri,) studied this question.