Blood Pressure Variability and Neurologic Outcome After Endovascular Thrombectomy: A Secondary Analysis of the BEST Study
Background and Purpose- Although higher blood pressure variability (BPV) is associated with worse functional outcome after stroke, this association is not as well established in large vessel occlusion strokes treated with endovascular treatment (EVT). Methods- In this post hoc analysis of BEST (Bloo...
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| Veröffentlicht in: | Stroke (1970) 2020-02, Vol.51 (2), p.511-518 |
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| creator | Mistry, Eva A. Mehta, Tapan Mistry, Akshitkumar Arora, Niraj Starosciak, Amy K. De Los Rios La Rosa, Felipe Siegler, James Ernest Chitale, Rohan Anadani, Mohammad Yaghi, Shadi Khatri, Pooja de Havenon, Adam |
| description | Background and Purpose- Although higher blood pressure variability (BPV) is associated with worse functional outcome after stroke, this association is not as well established in large vessel occlusion strokes treated with endovascular treatment (EVT). Methods- In this post hoc analysis of BEST (Blood Pressure after Endovascular Therapy for Ischemic Stroke), a prospective, multicenter cohort study of anterior circulation acute ischemic stroke patients undergoing EVT, we determined the association of BPV with poor outcome or death (90-day modified Rankin Scale, 3-6). We calculated BPV during the first 24 hours after EVT for systolic and diastolic BP using 5 methodologies, then divided BPV into tertiles and compared the highest to lowest tertile using logistic regression. Results- Of the 443 patients included in our analysis, 259 (58.5%) had a poor outcome, and 79 (17.8%) died. All measures of BPV were significantly higher in patients with poor outcome or death, but the difference was more pronounced for systolic than diastolic BPV. In the logistic regression, the highest tertile of systolic BPV consistently predicted poor outcome (odds ratio, 1.8-3.5, all |
| doi_str_mv | 10.1161/STROKEAHA.119.027549 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8010595</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2322808039</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3562-7f56a740c861b3b087e0691160f13114ba2ae63d9fe6062b7174596085ee2ced3</originalsourceid><addsrcrecordid>eNpVkVFv1DAMxysEYsfgGyCUR166OUmbNjwgddPBEBOHuIPXKE3dtZA2I2k39dsvpxsHSJYsy_bf1v-XJK8pnFEq6Pl2923zeV1dVbGUZ8CKPJNPkhXNWZZmgpVPkxUAlynLpDxJXoTwEwAYL_PnyQmnJeVc0FWyXFjnGvLVYwizR_JD-17Xve2nheixIV9w9s66m96QzTwZNyCp2gk9WY-Nu9PBzFZ7suu8G2o0kxuWd6QiWzRubLRfSDVqu4Q-ENeSqUNysd7uyHaam-Vl8qzVNuCrx3yafP-w3l1epdebj58uq-vU8FywtGhzoYsMTClozWsoCwQhowPQUk5pVmumUfBGtihAsLqgRZZLAWWOyAw2_DR5f9C9nesBG4Pj5LVVt74f4oPK6V793xn7Tt24O1UChVzmUeDto4B3v2cMkxr6YNBaPaKbg2KcsRLK6HUczQ6jxrsQPLbHMxTUnpo6UoulVAdqce3Nvy8el_5g-qt772w0P_yy8z161aG2U6ciVyhEASkDBvuAdI-a8QdP76TQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2322808039</pqid></control><display><type>article</type><title>Blood Pressure Variability and Neurologic Outcome After Endovascular Thrombectomy: A Secondary Analysis of the BEST Study</title><source>Journals@Ovid Ovid Autoload</source><source>MEDLINE</source><source>American Heart Association Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Mistry, Eva A. ; Mehta, Tapan ; Mistry, Akshitkumar ; Arora, Niraj ; Starosciak, Amy K. ; De Los Rios La Rosa, Felipe ; Siegler, James Ernest ; Chitale, Rohan ; Anadani, Mohammad ; Yaghi, Shadi ; Khatri, Pooja ; de Havenon, Adam</creator><creatorcontrib>Mistry, Eva A. ; Mehta, Tapan ; Mistry, Akshitkumar ; Arora, Niraj ; Starosciak, Amy K. ; De Los Rios La Rosa, Felipe ; Siegler, James Ernest ; Chitale, Rohan ; Anadani, Mohammad ; Yaghi, Shadi ; Khatri, Pooja ; de Havenon, Adam</creatorcontrib><description>Background and Purpose- Although higher blood pressure variability (BPV) is associated with worse functional outcome after stroke, this association is not as well established in large vessel occlusion strokes treated with endovascular treatment (EVT). Methods- In this post hoc analysis of BEST (Blood Pressure after Endovascular Therapy for Ischemic Stroke), a prospective, multicenter cohort study of anterior circulation acute ischemic stroke patients undergoing EVT, we determined the association of BPV with poor outcome or death (90-day modified Rankin Scale, 3-6). We calculated BPV during the first 24 hours after EVT for systolic and diastolic BP using 5 methodologies, then divided BPV into tertiles and compared the highest to lowest tertile using logistic regression. Results- Of the 443 patients included in our analysis, 259 (58.5%) had a poor outcome, and 79 (17.8%) died. All measures of BPV were significantly higher in patients with poor outcome or death, but the difference was more pronounced for systolic than diastolic BPV. In the logistic regression, the highest tertile of systolic BPV consistently predicted poor outcome (odds ratio, 1.8-3.5, all
<0.05). The rate of death within 90 days was 10.1% in the tertile with the lowest systolic BPV versus 25.2% in the tertile with the highest BPV (
<0.001). Conclusions- In EVT-treated stroke patients, higher BPV in the first 24 hours is associated with worse 90-day outcome. This association was more robust for systolic BPV. The mechanism by which BPV may exert a negative influence on neurological outcome remains unknown, but the consistency of this association warrants further investigation and potentially intervention.</description><identifier>ISSN: 0039-2499</identifier><identifier>EISSN: 1524-4628</identifier><identifier>DOI: 10.1161/STROKEAHA.119.027549</identifier><identifier>PMID: 31813361</identifier><language>eng</language><publisher>United States: American Heart Association, Inc</publisher><subject>Aged ; Aged, 80 and over ; Blood Pressure - physiology ; Blood Pressure Determination - methods ; Brain Ischemia - physiopathology ; Brain Ischemia - therapy ; Cerebral Infarction - complications ; Cerebral Infarction - therapy ; Endovascular Procedures - methods ; Female ; Humans ; Hypertension - complications ; Male ; Middle Aged ; Stroke - physiopathology ; Stroke - therapy ; Thrombectomy - methods ; Treatment Outcome</subject><ispartof>Stroke (1970), 2020-02, Vol.51 (2), p.511-518</ispartof><rights>American Heart Association, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3562-7f56a740c861b3b087e0691160f13114ba2ae63d9fe6062b7174596085ee2ced3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,3674,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31813361$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mistry, Eva A.</creatorcontrib><creatorcontrib>Mehta, Tapan</creatorcontrib><creatorcontrib>Mistry, Akshitkumar</creatorcontrib><creatorcontrib>Arora, Niraj</creatorcontrib><creatorcontrib>Starosciak, Amy K.</creatorcontrib><creatorcontrib>De Los Rios La Rosa, Felipe</creatorcontrib><creatorcontrib>Siegler, James Ernest</creatorcontrib><creatorcontrib>Chitale, Rohan</creatorcontrib><creatorcontrib>Anadani, Mohammad</creatorcontrib><creatorcontrib>Yaghi, Shadi</creatorcontrib><creatorcontrib>Khatri, Pooja</creatorcontrib><creatorcontrib>de Havenon, Adam</creatorcontrib><title>Blood Pressure Variability and Neurologic Outcome After Endovascular Thrombectomy: A Secondary Analysis of the BEST Study</title><title>Stroke (1970)</title><addtitle>Stroke</addtitle><description>Background and Purpose- Although higher blood pressure variability (BPV) is associated with worse functional outcome after stroke, this association is not as well established in large vessel occlusion strokes treated with endovascular treatment (EVT). Methods- In this post hoc analysis of BEST (Blood Pressure after Endovascular Therapy for Ischemic Stroke), a prospective, multicenter cohort study of anterior circulation acute ischemic stroke patients undergoing EVT, we determined the association of BPV with poor outcome or death (90-day modified Rankin Scale, 3-6). We calculated BPV during the first 24 hours after EVT for systolic and diastolic BP using 5 methodologies, then divided BPV into tertiles and compared the highest to lowest tertile using logistic regression. Results- Of the 443 patients included in our analysis, 259 (58.5%) had a poor outcome, and 79 (17.8%) died. All measures of BPV were significantly higher in patients with poor outcome or death, but the difference was more pronounced for systolic than diastolic BPV. In the logistic regression, the highest tertile of systolic BPV consistently predicted poor outcome (odds ratio, 1.8-3.5, all
<0.05). The rate of death within 90 days was 10.1% in the tertile with the lowest systolic BPV versus 25.2% in the tertile with the highest BPV (
<0.001). Conclusions- In EVT-treated stroke patients, higher BPV in the first 24 hours is associated with worse 90-day outcome. This association was more robust for systolic BPV. The mechanism by which BPV may exert a negative influence on neurological outcome remains unknown, but the consistency of this association warrants further investigation and potentially intervention.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Blood Pressure - physiology</subject><subject>Blood Pressure Determination - methods</subject><subject>Brain Ischemia - physiopathology</subject><subject>Brain Ischemia - therapy</subject><subject>Cerebral Infarction - complications</subject><subject>Cerebral Infarction - therapy</subject><subject>Endovascular Procedures - methods</subject><subject>Female</subject><subject>Humans</subject><subject>Hypertension - complications</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Stroke - physiopathology</subject><subject>Stroke - therapy</subject><subject>Thrombectomy - methods</subject><subject>Treatment Outcome</subject><issn>0039-2499</issn><issn>1524-4628</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkVFv1DAMxysEYsfgGyCUR166OUmbNjwgddPBEBOHuIPXKE3dtZA2I2k39dsvpxsHSJYsy_bf1v-XJK8pnFEq6Pl2923zeV1dVbGUZ8CKPJNPkhXNWZZmgpVPkxUAlynLpDxJXoTwEwAYL_PnyQmnJeVc0FWyXFjnGvLVYwizR_JD-17Xve2nheixIV9w9s66m96QzTwZNyCp2gk9WY-Nu9PBzFZ7suu8G2o0kxuWd6QiWzRubLRfSDVqu4Q-ENeSqUNysd7uyHaam-Vl8qzVNuCrx3yafP-w3l1epdebj58uq-vU8FywtGhzoYsMTClozWsoCwQhowPQUk5pVmumUfBGtihAsLqgRZZLAWWOyAw2_DR5f9C9nesBG4Pj5LVVt74f4oPK6V793xn7Tt24O1UChVzmUeDto4B3v2cMkxr6YNBaPaKbg2KcsRLK6HUczQ6jxrsQPLbHMxTUnpo6UoulVAdqce3Nvy8el_5g-qt772w0P_yy8z161aG2U6ciVyhEASkDBvuAdI-a8QdP76TQ</recordid><startdate>20200201</startdate><enddate>20200201</enddate><creator>Mistry, Eva A.</creator><creator>Mehta, Tapan</creator><creator>Mistry, Akshitkumar</creator><creator>Arora, Niraj</creator><creator>Starosciak, Amy K.</creator><creator>De Los Rios La Rosa, Felipe</creator><creator>Siegler, James Ernest</creator><creator>Chitale, Rohan</creator><creator>Anadani, Mohammad</creator><creator>Yaghi, Shadi</creator><creator>Khatri, Pooja</creator><creator>de Havenon, Adam</creator><general>American Heart Association, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20200201</creationdate><title>Blood Pressure Variability and Neurologic Outcome After Endovascular Thrombectomy: A Secondary Analysis of the BEST Study</title><author>Mistry, Eva A. ; Mehta, Tapan ; Mistry, Akshitkumar ; Arora, Niraj ; Starosciak, Amy K. ; De Los Rios La Rosa, Felipe ; Siegler, James Ernest ; Chitale, Rohan ; Anadani, Mohammad ; Yaghi, Shadi ; Khatri, Pooja ; de Havenon, Adam</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3562-7f56a740c861b3b087e0691160f13114ba2ae63d9fe6062b7174596085ee2ced3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Blood Pressure - physiology</topic><topic>Blood Pressure Determination - methods</topic><topic>Brain Ischemia - physiopathology</topic><topic>Brain Ischemia - therapy</topic><topic>Cerebral Infarction - complications</topic><topic>Cerebral Infarction - therapy</topic><topic>Endovascular Procedures - methods</topic><topic>Female</topic><topic>Humans</topic><topic>Hypertension - complications</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Stroke - physiopathology</topic><topic>Stroke - therapy</topic><topic>Thrombectomy - methods</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mistry, Eva A.</creatorcontrib><creatorcontrib>Mehta, Tapan</creatorcontrib><creatorcontrib>Mistry, Akshitkumar</creatorcontrib><creatorcontrib>Arora, Niraj</creatorcontrib><creatorcontrib>Starosciak, Amy K.</creatorcontrib><creatorcontrib>De Los Rios La Rosa, Felipe</creatorcontrib><creatorcontrib>Siegler, James Ernest</creatorcontrib><creatorcontrib>Chitale, Rohan</creatorcontrib><creatorcontrib>Anadani, Mohammad</creatorcontrib><creatorcontrib>Yaghi, Shadi</creatorcontrib><creatorcontrib>Khatri, Pooja</creatorcontrib><creatorcontrib>de Havenon, Adam</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Stroke (1970)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mistry, Eva A.</au><au>Mehta, Tapan</au><au>Mistry, Akshitkumar</au><au>Arora, Niraj</au><au>Starosciak, Amy K.</au><au>De Los Rios La Rosa, Felipe</au><au>Siegler, James Ernest</au><au>Chitale, Rohan</au><au>Anadani, Mohammad</au><au>Yaghi, Shadi</au><au>Khatri, Pooja</au><au>de Havenon, Adam</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Blood Pressure Variability and Neurologic Outcome After Endovascular Thrombectomy: A Secondary Analysis of the BEST Study</atitle><jtitle>Stroke (1970)</jtitle><addtitle>Stroke</addtitle><date>2020-02-01</date><risdate>2020</risdate><volume>51</volume><issue>2</issue><spage>511</spage><epage>518</epage><pages>511-518</pages><issn>0039-2499</issn><eissn>1524-4628</eissn><abstract>Background and Purpose- Although higher blood pressure variability (BPV) is associated with worse functional outcome after stroke, this association is not as well established in large vessel occlusion strokes treated with endovascular treatment (EVT). Methods- In this post hoc analysis of BEST (Blood Pressure after Endovascular Therapy for Ischemic Stroke), a prospective, multicenter cohort study of anterior circulation acute ischemic stroke patients undergoing EVT, we determined the association of BPV with poor outcome or death (90-day modified Rankin Scale, 3-6). We calculated BPV during the first 24 hours after EVT for systolic and diastolic BP using 5 methodologies, then divided BPV into tertiles and compared the highest to lowest tertile using logistic regression. Results- Of the 443 patients included in our analysis, 259 (58.5%) had a poor outcome, and 79 (17.8%) died. All measures of BPV were significantly higher in patients with poor outcome or death, but the difference was more pronounced for systolic than diastolic BPV. In the logistic regression, the highest tertile of systolic BPV consistently predicted poor outcome (odds ratio, 1.8-3.5, all
<0.05). The rate of death within 90 days was 10.1% in the tertile with the lowest systolic BPV versus 25.2% in the tertile with the highest BPV (
<0.001). Conclusions- In EVT-treated stroke patients, higher BPV in the first 24 hours is associated with worse 90-day outcome. This association was more robust for systolic BPV. The mechanism by which BPV may exert a negative influence on neurological outcome remains unknown, but the consistency of this association warrants further investigation and potentially intervention.</abstract><cop>United States</cop><pub>American Heart Association, Inc</pub><pmid>31813361</pmid><doi>10.1161/STROKEAHA.119.027549</doi><tpages>8</tpages></addata></record> |
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| subjects | Aged Aged, 80 and over Blood Pressure - physiology Blood Pressure Determination - methods Brain Ischemia - physiopathology Brain Ischemia - therapy Cerebral Infarction - complications Cerebral Infarction - therapy Endovascular Procedures - methods Female Humans Hypertension - complications Male Middle Aged Stroke - physiopathology Stroke - therapy Thrombectomy - methods Treatment Outcome |
| title | Blood Pressure Variability and Neurologic Outcome After Endovascular Thrombectomy: A Secondary Analysis of the BEST Study |
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