Prognostic Value of 24-H ABPM in Acute Ischemic Stroke for Short-, Medium-, and Long-Term Outcome: A Systematic Review and Meta-Analysis
Abstract
Background
The association of blood pressure levels during the acute phase of ischemic stroke with outcome remains controversial.
Aims
The objective of this systematic review is to assess the predictive value for stroke outcome assessed by the modified Rankin scale score of systolic and diastolic blood pressure, measured by ambulatory blood pressure monitoring methods during the acute phase of ischemic stroke, compared with the values of casually derived blood pressure measurement on admission.
Methods
We searched for studies with patients admitted within 24 h of stroke onset, and who had ambulatory blood pressure monitoring during the first 24 h of admission. We identified studies that reported blood pressure in those with good outcome and in those with poor outcome at end of follow-up, and performed a meta-analysis of the effect of mean blood pressure on outcome.
Results
High systolic and diastolic blood pressure levels derived with ambulatory blood pressure monitoring were associated with poor short-, medium-, and long-term outcome, but the same was not found for casual blood pressure measurements. An increase in systolic blood pressure of 9·1 mmHg (95% confidence interval: 6·6–11·6, P < 0·001; I2 = 9%) and an increase in diastolic blood pressure of 2·3 mmHg (95% confidence interval: 0·8–3·7, P = 0·002; I2 = 0%) were associated with poor outcome.
Conclusions
Higher systolic and diastolic blood pressure levels derived with ambulatory blood pressure monitoring were associated with poor outcome. The same was not found for higher casual blood pressure measurements on admission, and it is possible that ambulatory blood pressure monitoring conveys better prognostic information.
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References
1 Qureshi AI. Acute hypertensive response in patients with stroke: pathophysiology and management. Circulation 2008; 118:176–87.
2 Ntaios G, Lambrou D, Michel P. Blood pressure changes in acute ischemic stroke and outcome with respect to stroke etiology. Neurology 2012; 79:1440–8.
3 Ntaios G, Bath P, Michel P. Blood pressure treatment in acute ischemic stroke: a review of studies and recommendations. Curr Opin Neurol 2010; 23:46–52.
4 Ntaios G, Lambrou D, Michel P. Blood pressure change and outcome in acute ischemic stroke: the impact of baseline values, previous hypertensive disease and previous antihypertensive treatment. J Hypertens 2011; 29:1583–9.
5 Lawes CM, Bennett DA, Feigin VL, Rodgers A. Blood pressure and stroke: an overview of published reviews. Stroke 2004; 35:1024.
6 Robinson T, Waddington A, Ward-Close S, Taub N, Potter J. The predictive role of 24-hour compared to casual blood pressure levels on outcome following acute stroke. Cerebrovasc Dis 1997; 7:264–72.
7 Allen CM. Predicting the outcome of acute stroke: a prognostic score. J Neurol Neurosurg Psychiatry 1984; 47:475–80.
8 Jørgensen HS, Nakayama H, Raaschou HO, Olsen TS. Effect of blood pressure and diabetes on stroke in progression. Lancet 1994; 344:156–9.
9 Fotherby MD, Critchley D, Potter JF. Effect of hospitalization on conventional and 24-hour blood pressure. Age Ageing 1995; 24:25–9.
10 Coats AJ. Reproducibility or variability of casual and ambulatory blood pressure data: implications for clinical trials. J Hypertens Suppl 1990; 8:S17–20.
11 Verdecchia P, Schillaci G, Guerrieri M, et al. Circadian blood pressure changes and left ventricular hypertrophy in essential hypertension. Circulation 1990; 81:528–36.
12 O'Brien E, Parati G, Stergiou G, et al. European Society of Hypertension position paper on ambulatory blood pressure monitoring. J Hypertens 2013; 31:1731–68.
13 van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1988; 19:604–7.
14 Wells GA, Shea B, O'Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2013. Available at http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp (accessed 20 June 2014).
15 Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0: The Cochrane Collaboration; 2011. Available at http://www.cochrane-handbook.org (accessed 1 June 2013).
16 Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009; 339:b2535.
17 Panayiotou BN, Taub NA, Fotherby MD. Twenty-four-hour blood pressure profiles following stroke. Blood Press Monit 1996; 1:409–14.
18 Bhalla A, Wolfe CD, Rudd AG. The effect of 24 h blood pressure levels on early neurological recovery after stroke. J Intern Med 2001; 250:121–30.
19 Robinson TG, Dawson SL, Eames PJ, Panerai RB, Potter JF. Cardiac baroreceptor sensitivity predicts long-term outcome after acute ischemic stroke. Stroke 2003; 34:705–12.
20 Rodríguez-García JL, Botia E, de La Sierra A, Villanueva MA, González-Spínola J. Significance of elevated blood pressure and its management on the short-term outcome of patients with acute ischemic stroke. Am J Hypertens 2005; 18:379–84.
21 Tsivgoulis G, Spengos K, Zakopoulos N, et al. Twenty four hour pulse pressure predicts long term recurrence in acute stroke patients. J Neurol Neurosurg Psychiatry 2005; 76:1360–5.
22 Delgado-Mederos R, Ribo M, Rovira A, et al. Prognostic significance of blood pressure variability after thrombolysis in acute stroke. Neurology 2008; 71:552–8.
23 Tomii Y, Toyoda K, Suzuki R, et al. Effects of 24-hour blood pressure and heart rate recorded with ambulatory blood pressure monitoring on recovery from acute ischemic stroke. Stroke 2011; 42:3511–7.
24 Weiss A, Beloosesky Y, Kenett RS, Grossman E. Systolic blood pressure during acute stroke is associated with functional status and long-term mortality in the elderly. Stroke 2013; 44:2434–40.
25 Carlberg B, Asplund K, Hägg E. Factors influencing admission blood pressure levels in patients with acute stroke. Stroke 1991; 22:527–30.
26 Harper G, Fotherby MD, Panayiotou BJ, Castleden CM, Potter JF. The changes in blood pressure after acute stroke: abolishing the ‘white coat effect’ with 24-h ambulatory monitoring. J Intern Med 1994; 235:343–6.
27 Kellert L, Sykora M, Gumbinger C, Herrmann O, Ringleb PA. Blood pressure variability after intravenous thrombolysis in acute stroke does not predict intracerebral hemorrhage but poor outcome. Cerebrovasc Dis 2012; 33:135–40.
28 Yong M, Diener HC, Kaste M, Mau J. Characteristics of blood pressure profiles as predictors of long-term outcome after acute ischemic stroke. Stroke 2005; 36:2619–25.
29 Yong M, Kaste M. Association of characteristics of blood pressure profiles and stroke outcomes in the ECASS-II trial. Stroke 2008; 39:366–72.
30 Cuffe RL, Howard SC, Algra A, Warlow CP, Rothwell PM. Mediumterm variability of blood pressure and potential underdiagnosis of hypertension in patients with previous transient ischemic attack or minor stroke. Stroke 2006; 37:2776–83.
31 Rothwell PM. Limitations of the usual blood-pressure hypothesis and importance of variability, instability, and episodic hypertension. Lancet 2010; 375:938–48.
32 Geeganage C, Tracy M, England T, et al. Relationship between baseline blood pressure parameters (including mean pressure, pulse pressure, and variability) and early outcome after stroke: data from the Tinzaparin in Acute Ischaemic Stroke Trial (TAIST). Stroke 2011; 42:491–3.
33 Ko Y, Park JH, Yang MH, et al. The significance of blood pressure variability for the development of hemorrhagic transformation in acute ischemic stroke. Stroke 2010; 41:2512–8.
34 Verdecchia P, Porcellati C, Schillaci G, et al. Ambulatory blood pressure. An independent predictor of prognosis in essential hypertension. Hypertension 1994; 24:793–801.
35 Yamamoto Y, Akiguchi I, Oiwa K, Hayashi M, Kimura J. Adverse effect of nighttime blood pressure on the outcome of lacunar infarct patients. Stroke 1998; 29:570–6.
36 Sander D, Klingelhöfer J. Changes of circadian blood pressure patterns after hemodynamic and thromboembolic brain infarction. Stroke 1994; 25:1730–7.
37 Tsivgoulis G, Ntaios G. Blood pressure variability in subacute ischemic stroke: a neglected potential therapeutic target. Neurology 2012; 79:2014–5.
38 National Library of Medicine (NLM) at the National Institutes of Health (NIH). ClinicalTrials.gov. 2013. Available at http://clinicaltrials.gov/show/NCT01915862 (accessed 20 June 2014).
Additional Supporting Information may be found in the online version of this article at the publisher's web-site:
Figure S1. Galbraith plot of DBP measured by ABPM (short-term).
Figure S2. Galbraith plot of standard deviation of SBP measured by ABPM.
Figure S3. Galbraith plot of standard deviation of DBP measured by ABPM.
Figure S4. Counter-enhanced funnel plots for asymmetry and the Egger's test.
Figure S5. Counter-enhanced funnel plots for asymmetry and the Egger's test of nocturnal BP dipping and standard deviation of BP.
Figure S6. Sensitivity analysis.
Table S1. Quality assessment by the Newcastle-Ottawa quality scale.
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Article first published online: August 18, 2015
Issue published: October 2015
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PubMed: 26283262
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