Visit-to-visit systolic blood pressure variability predicts all-cause and cardiovascular mortality after lacunar infarct

Abstract

OBJECTIVE: To determine the prognostic implications of outpatient clinic visit-to-visit blood pressure variability (BPV) in patients with lacunar infarct. BACKGROUND: Both blood pressure (BP) and its variability (BPV) are established risk factors for development of atherosclerotic disease and are associated with an increased risk for cardiovascular and all-cause mortality. The prognostic implications of outpatient clinic visit-to-visit BPV amongst patients with lacunar infarction are nevertheless unknown. METHODS: We prospectively followed-up the clinical outcome of 281 patients with lacunar infarction. The average BP and BPV, as determined by the standard deviation of the systolic and diastolic BP, were recorded during a mean 13±6 outpatient clinic visits. RESULTS: The mean age of the population was 70±10 years. After a mean 78±18 month's follow-up, 65 patients died (23%), 31% (20/65) were due to cardiovascular causes. 14% and 7% developed recurrent stroke and acute coronary syndrome. After adjusting for age, sex, mean systolic and diastolic BP, cardiovascular risk factors and co-morbidities, patients with a systolic BPV of the third tertile had significantly higher risk of all-cause (hazards ratio [HR] 1.97, 95% confidence interval [CI] 1.02-3.80, P=0.04) and cardiovascular mortality (HR 7.64, 95% CI 1.65-35.41, P<0.01) compared to those with systolic BPV of the first tertile. Nevertheless, systolic BPV did not predict recurrent stroke or acute coronary syndrome. Diastolic BPV did not predict various adverse clinical outcomes. CONCLUSIONS: Visit-to-visit systolic BPV predicts long-term all-cause and cardiovascular mortality after lacunar infarct, independent of conventional risk factors including average BP control.