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Article: Long-Term Prognostic Implications of Visit-to-Visit Blood Pressure Variability in Patients With Ischemic Stroke

TitleLong-Term Prognostic Implications of Visit-to-Visit Blood Pressure Variability in Patients With Ischemic Stroke
Authors
Issue Date2014
PublisherNature Publishing Group. The Journal's web site is located at http://www.nature.com/ajh/index.html
Citation
American Journal of Hypertension, 2014, v. 27 n. 12, p. 1486-1494 How to Cite?
AbstractBACKGROUND: Blood pressure (BP) variability (BPV) is a novel risk factor for the development of atherosclerotic diseases. High BPV has recently been shown to predict all-cause and cardiovascular mortality in patients with lacunar infarct. Whether BPV has prognostic implications in patients with ischemic stroke subtypes, other than those due to small-vessel occlusion, remains uncertain. METHODS: We prospectively followed up the clinical outcome of 632 consecutive ischemic stroke patients without atrial fibrillation. The average BP and BPV, as determined by the coefficient of variation of the systolic and diastolic BP, were recorded during a mean 12 ± 6 outpatient clinic visits. RESULTS: The average age of the population was 71 ± 11 years. After a mean of 76 ± 18 months of follow-up, 161 patients died (26%); 35% (n = 56 of 161) of these deaths were due to cardiovascular causes. Sixteen percent and 5% developed recurrent stroke and acute coronary syndrome (ACS), respectively. After adjusting for mean systolic BP and confounding variables, patients with high systolic BPV were at significantly greater risk of cardiovascular mortality (hazards ratio (HR) = 2.36; 95% confidence interval (CI) = 1.02-5.49; P < 0.05). High systolic BPV also predicted all-cause mortality after adjusting for mean systolic BP (HR = 1.79; 95% CI = 1.16-2.75; P < 0.05). There was no association between systolic BPV and nonfatal recurrent stroke or nonfatal ACS. Raised diastolic BPV did not predict recurrent nonfatal stroke, nonfatal ACS, or mortality. CONCLUSIONS: Visit-to-visit systolic BPV predicts long-term all-cause and cardiovascular mortality in patients with ischemic stroke without atrial fibrillation, independent of other conventional risk factors, including average BP control.
Persistent Identifierhttp://hdl.handle.net/10722/198042
ISSN
2015 Impact Factor: 3.182
2015 SCImago Journal Rankings: 1.397

 

DC FieldValueLanguage
dc.contributor.authorLau, GKK-
dc.contributor.authorWong, YK-
dc.contributor.authorTeo, KC-
dc.contributor.authorChang, RSK-
dc.contributor.authorChan, KH-
dc.contributor.authorHon, SFK-
dc.contributor.authorWat, KL-
dc.contributor.authorCheung, RTF-
dc.contributor.authorLi, LSW-
dc.contributor.authorSiu, DCW-
dc.contributor.authorTse, HF-
dc.date.accessioned2014-06-25T02:42:07Z-
dc.date.available2014-06-25T02:42:07Z-
dc.date.issued2014-
dc.identifier.citationAmerican Journal of Hypertension, 2014, v. 27 n. 12, p. 1486-1494-
dc.identifier.issn0895-7061-
dc.identifier.urihttp://hdl.handle.net/10722/198042-
dc.description.abstractBACKGROUND: Blood pressure (BP) variability (BPV) is a novel risk factor for the development of atherosclerotic diseases. High BPV has recently been shown to predict all-cause and cardiovascular mortality in patients with lacunar infarct. Whether BPV has prognostic implications in patients with ischemic stroke subtypes, other than those due to small-vessel occlusion, remains uncertain. METHODS: We prospectively followed up the clinical outcome of 632 consecutive ischemic stroke patients without atrial fibrillation. The average BP and BPV, as determined by the coefficient of variation of the systolic and diastolic BP, were recorded during a mean 12 ± 6 outpatient clinic visits. RESULTS: The average age of the population was 71 ± 11 years. After a mean of 76 ± 18 months of follow-up, 161 patients died (26%); 35% (n = 56 of 161) of these deaths were due to cardiovascular causes. Sixteen percent and 5% developed recurrent stroke and acute coronary syndrome (ACS), respectively. After adjusting for mean systolic BP and confounding variables, patients with high systolic BPV were at significantly greater risk of cardiovascular mortality (hazards ratio (HR) = 2.36; 95% confidence interval (CI) = 1.02-5.49; P < 0.05). High systolic BPV also predicted all-cause mortality after adjusting for mean systolic BP (HR = 1.79; 95% CI = 1.16-2.75; P < 0.05). There was no association between systolic BPV and nonfatal recurrent stroke or nonfatal ACS. Raised diastolic BPV did not predict recurrent nonfatal stroke, nonfatal ACS, or mortality. CONCLUSIONS: Visit-to-visit systolic BPV predicts long-term all-cause and cardiovascular mortality in patients with ischemic stroke without atrial fibrillation, independent of other conventional risk factors, including average BP control.-
dc.languageeng-
dc.publisherNature Publishing Group. The Journal's web site is located at http://www.nature.com/ajh/index.html-
dc.relation.ispartofAmerican Journal of Hypertension-
dc.titleLong-Term Prognostic Implications of Visit-to-Visit Blood Pressure Variability in Patients With Ischemic Stroke-
dc.typeArticle-
dc.identifier.emailLau, GKK: gkklau@hku.hk-
dc.identifier.emailWong, YK: debbieyk@hku.hk-
dc.identifier.emailChang, RSK: skrchang@hku.hk-
dc.identifier.emailChan, KH: koonho@hku.hk-
dc.identifier.emailWat, KL: dgwatkl@hku.hk-
dc.identifier.emailCheung, RTF: rtcheung@hku.hk-
dc.identifier.emailLi, LSW: lswli@hkucc.hku.hk-
dc.identifier.emailSiu, DCW: cwdsiu@hkucc.hku.hk-
dc.identifier.emailTse, HF: hftse@hkucc.hku.hk-
dc.identifier.authorityLau, GKK=rp01499-
dc.identifier.authorityChan, KH=rp00537-
dc.identifier.authorityCheung, RTF=rp00434-
dc.identifier.authoritySiu, DCW=rp00534-
dc.identifier.authorityTse, HF=rp00428-
dc.identifier.doi10.1093/ajh/hpu070-
dc.identifier.pmid24842389-
dc.identifier.hkuros229256-
dc.identifier.volume27-
dc.identifier.issue12-
dc.identifier.spage1486-
dc.identifier.epage1494-
dc.publisher.placeUnited States-

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