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Blood pressure variability predicts poor outcomes in acute stroke patients without thrombolysis: a systematic review and meta-analysis

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Abstract

Background

Stroke is a significant medical condition, and blood pressure stands out as the most prevalent treatable risk factor associated with it. Researches link blood pressure variability (BPV) with stroke; however, the specific relationship between with the outcomes of stroke patients remains unclear. As blood pressure variability and mean blood pressure are interrelated, it remains uncertain whether BPV adds additional information to understanding the outcome of acute stroke patients.

Objective

To systematically review studies investigating the association between blood pressure variability and prognosis in acute stroke patients.

Methods

Embase, PubMed, Web of Science, and the Cochrane Library were searched for English language full-text articles from the inception to 1 January 2023. Stroke patients aged ≥ 18 years were included in this analysis. Stroke types were not restricted.

Results

This meta-analysis shows that higher systolic blood pressure variability is linked to a higher risk of poor outcome, including function disability, mortality, early neurological deterioration, and stroke recurrence, among acute stroke patients without thrombolysis. A higher diastolic blood pressure variability is linked with to a higher risk of mortality and functional disability.

Conclusions

This review reveals that blood pressure variability is a novel and clinically relevant risk factor for stroke patients’ outcome. Future studies should investigate how best to measure and define BPV in acute stroke. Larger studies are warranted to provide more robust evidence in this area.

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Data availability

The data that support the findings of this study are available from the corresponding author, Yuxia Ma, upon reasonable request.

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Author notes

  1. Yajing Chen and Yuxia Ma made equal contributions to this manuscript, should be regarded as co-first authors.

Authors and Affiliations

  1. Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China

    Yajing Chen, Yuxia Ma, Jiangxia Qin, Xiaoqin Wei, Yiyi Yang, Yue Yuan, Fanghong Yan & Lin Han

  2. Department of Nursing, Gansu Provincial Hospital, No. 204 Donggang West Road, Lanzhou, Gansu Province, China

    Lin Han

  3. The Third People’s Hospital of Lanzhou, No.130 Jianlan New Village, Lanzhou, Gansu Province, China

    Xiaoning Huo

  4. The First Clinical Medical College of Lanzhou University, Lanzhou, 730030, Gansu Province, China

    Yuxia Ma

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  1. Yajing Chen
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All authors contributed to the study conception and design. The first draft of the manuscript was written by YJ and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Chen, Y., Ma, Y., Qin, J. et al. Blood pressure variability predicts poor outcomes in acute stroke patients without thrombolysis: a systematic review and meta-analysis. J Neurol 271, 1160–1169 (2024). https://doi.org/10.1007/s00415-023-12054-w

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