Autonomic function may mediate the neuroprotection of remote ischemic postconditioning in stroke: A randomized controlled trial

•This is the first human-based study providing evidence for a mediation role of autonomic function between RIpostC and prognosis in AIS patients.•This study indicated that RIPostC could improve neurological outcome of AIS patients. Autonomic function may play a mediating role in this association.•These findings not only help better understand the underlying mechanism of RIpostC but also provide evidences for the clinical implementation of RIPostC on AIS patients to better their neurological outcomes. To evaluate the effect of remote ischemic postconditioning (RIPostC) on the prognosis of acute ischemic stroke(AIS) patients and investigate the mediating role of autonomic function in the neuroprotection of RIPostC. 132 AIS patients were randomized into two groups. Patients received four cycles of 5-min inflation to a pressure of 200 mmHg(i.e., RIPostC) or patients’ diastolic BP(i.e., shame), followed by 5 min of deflation on healthy upper limbs once a day for 30 days. The main outcome was neurological outcome including the National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and Barthel index(BI). The second outcome measure was autonomic function measured by heart rate variability(HRV). Compared with the baseline, the post-intervention NIHSS score was significantly reduced in both groups (P