Introduction Evidence based blood pressure (BP) targets in acute ischemic stroke are lacking. Previous observational studies have focused on single baseline BP and clinical outcomes, without consideration for dynamic changes. We aim to determine the association between BP parameters including variability, peak, nadir, median and mean during stroke and infarct growth (primary outcome), risk of haemorrhagic transformation and functional outcome (secondary outcomes). Methods Suspected stroke patients were prospectively recruited from a single comprehensive stroke centre. Multimodal computed tomography imaging was used to define infarct core. BP was recorded as per national stroke guidelines during the initial 24-hours. Infarct growth and evidence of parenchymal haemorrhage were determined by follow-up magnetic resonance imaging at 24 hours. Functional outcome at 3-months was assessed using the modified Rankin Scale. Subgroup analysis was performed according to stroke etiology and treatment for the association between BP, infarct volume growth and risk of hemorrhagic transformation. The association between BP parameters and outcomes were determined using regression modelling. Results A total of 229 patients were included in this study. The median age was 67.4, 64.4% were male and the baseline National Institutes of Health Stroke Scale was 8. Blood pressure variability (BPV) was independently associated with increased infarct growth (multivariate coefficient 1.60, 95% CI 0.27-2.94, P=0.019) and an increased odds of parenchymal haemorrhage (adjusted OR 1.21, 95% CI 1.02-1.44, P= 0.028). The odds of a favourable outcome at 90 days were inversely associated with BPV on simple, but not adjusted logistic regression. On subgroup analysis, only in patients with large vessel occlusions undergoing endovascular clot retrieval was BPV associated with infarct growth (multivariate adjusted coefficient 2.62, 95% CI 0.53-4.70, P=0.014) and an increased odds of hemorrhagic transformation (adjusted OR 1.26, 95% CI 1.01-1.57, P=0.045). Conclusions: An increase in BPV was associated with infarct expansion, increased risk of haemorrhagic transformation, and was negatively associated with favourable functional outcomes at 3-months.

中文翻译：

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血压变异性与急性缺血性中风的梗塞生长有关。

简介 急性缺血性卒中缺乏基于证据的血压 (BP) 目标。以前的观察性研究侧重于单一基线血压和临床结果，没有考虑动态变化。我们的目标是确定血压参数之间的关联，包括卒中和梗死发展期间的变异性、峰值、最低点、中值和平均值（主要结果）、出血转化风险和功能结果（次要结果）。方法 前瞻性地从单一综合性卒中中心招募疑似卒中患者。使用多模态计算机断层扫描成像来定义梗塞核心。在最初 24 小时内按照国家卒中指南记录血压。通过 24 小时的后续磁共振成像确定梗塞生长和实质出血的证据。使用改良Rankin量表评估3个月时的功能结果。根据卒中病因和治疗进行亚组分析，以了解血压、梗塞体积增长和出血转化风险之间的关联。使用回归模型确定血压参数和结果之间的关联。结果本研究共纳入229例患者。中位年龄为 67.4 岁，64.4% 为男性，基线美国国立卫生研究院卒中量表为 8。血压变异性 (BPV) 与梗塞生长增加独立相关（多变量系数 1.60，95% CI 0.27-2.94，P=0.019 ）和实质出血的几率增加（调整后 OR 1.21，95% CI 1.02-1.44，P= 0.028）。在简单但未经调整的逻辑回归中，90 天时出现良好结果的几率与 BPV 呈负相关。在亚组分析中，仅在接受血管内血栓取出的大血管闭塞患者中，BPV 与梗塞生长相关（多变量调整系数 2.62，95% CI 0.53-4.70，P=0.014）和出血转化几率增加（调整 OR 1.26， 95% CI 1.01-1.57，P=0.045）。结论：BPV 增加与梗塞扩张、出血转化风险增加相关，并且与 3 个月时良好的功能结果呈负相关。