Blood Pressure Variability and Early Neurological Outcomes in Acute and Subacute Stroke in Southwestern Uganda

Authors

Shirley M. Moore, Case Western Reserve UniversityFollow
Martha Sajatovic, Case Western Reserve UniversityFollow

Author ORCID Identifier

Martha Sajatovic

Document Type

Article

Publication Date

10-16-2023

Abstract

Background: Greater blood pressure variability has detrimental effects on clinical outcome after a stroke; its effects are controversial and have not been evaluated in Sub-Saharan Africa (SSA). Methods: We conducted a prospective study of patients with CT head confirmed ischemic and hemorrhagic strokes admitted to a tertiary hospital within 7 days of onset of unilateral neurological deficits. Blood pressure variability indices, standard deviation (SD) and coefficient of variation (CV) of systolic and diastolic blood pressure between day 0 and day 7, were calculated with a subsequent modified Rankin Scale (mRS) score on day 14 post-stroke. Linear regression was performed to determine the exponential coefficients of mortality at 14 days post- stroke. Results: Out of 120 patients, 51.7% were female, 52.5% had ischemic stroke and the overall median age was 65 (IQR 54–80) years. Twenty (16.7%) patients died within a median survival time of 7 days, while 32 (26.7%) died by day 14 post-stroke. Patients with hemorrhagic stroke had an overall SDSBP of 16.44 mmHg while those with ischemic stroke had an overall SDSBP of 14.05 mmHg. In patients with ischemic stroke, SDSBP had adjusted coefficients of 1, p = 0.004 with C·I: 1.01–1.04 and NIHSS had adjusted coefficients of 1, p = 0.019 with C·I: 1.00–1.03 while in patients with hemorrhagic stroke, SDSBP had adjusted coefficients of 1, p = 0.045 with C·I: 1.00–1.04 and NIHSS had adjusted coefficients of 1, p ≤0.001 with C·I: 1.01–1.03. Conclusion: Exponential increase in Blood Pressure Variability (BPV) and stroke severity scale were independently associated with early mortality among all stroke patients in our study. We recommend future studies to evaluate whether controlling BPV among patients with stroke in Sub-Saharan Africa can reduce mortality.

Keywords

blood pressure variability, cerebral infarction, Intracerebral hemorrhage, outcomes, stroke, sub-Saharan Africa

Language

English

Publication Title

Eneurologicalsci

Grant

1R01NS118544-01

Rights

© The Author(s) 2023. This is an Open Access work distributed under the terms of the Creative Commons Attribution Licence (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Recommended Citation

Kulaba N, Kayanja A, Serubiri D, Mukasa MK, Kaddumukasa M, Nakibuuka J, Moore SM, Katabira ET, Sajatovic M, O'Carroll CB, Muyingo A. Blood pressure variability and early neurological outcomes in acute and subacute stroke in Southwestern Uganda. eNeurologicalSci. 2023 Oct 16;33:100482. doi: 10.1016/j.ensci.2023.100482. PMID: 38020074; PMCID: PMC10630106.