Correlation between 24-hour blood pressure and blood pressure variability and 90-day functional outcomes in patients with acute ischemic stroke after early anticoagulation with intravenous argatroban
Authors: Hu lan , Jin Dong-gan , Hu Wenshi , Xu Yuan , Shi Yun 
Published: April 2022

Abstract
Background: Blood pressure (BP) fluctuation is a common phenomenon in acute ischemic stroke (AIS), but the effect of fluctuations in BP during specific treatment on adverse events has received less attention. Therefore, we explored the relationship between both BP and 24-hour BP variation (BPV) and 90-day functional outcomes (assessed by modified Rankin Scale [mRS] score) in patients with AIS who underwent intravenous argatroban therapy within 24 hours of AIS onset. Methods: A total of 214 patients with AIS who were hospitalized with neurological deficiency within 24 hours and who underwent intravenous argatroban therapy were included. BP was monitored using a cuff at fixed intervals of 1 hour, and mean systolic blood pressure (mean-SBP), maximum SBP (max-SBP), minimum SBP (min-SBP), mean diastolic blood pressure (mean-DBP), maximum DBP (max-DBP), minimum DBP (min-DBP), mean arterial pressure (MAP), standard deviation (SD), coefficient of variation (CV), successive variation (SV), and average real variability (ARV) were calculated. The correlation between both BP and BPV and 90-day mRS score was evaluated by logistic regression after adjusting for confounding variables. Results: Two-hundred fourteen patients were included in the study, including 123 patients with a good prognosis (mRS score ≤ 2) (57.48%) and 91 patients with a poor prognosis (mRS score > 2) (42.52%). Age, National Institutes of Health Stroke Scale (NIHSS) score on admission, diabetes mellitus (DM), infarction location (anterior circulation), and prognosis were significantly related (P < 0.05). After one-way analysis of variance on BP and BPV, variables with a P value of <0.2 were used as conditions for a significant correlation with prognosis. BP and BPV parameters in the good prognosis group were higher than in the poor prognosis group. In the adjusted logistic regression model, mean-SBP in Model 1 (adjusted for age and NIHSS score) was significantly associated with 3-month mRS score (odds ratio [OR] = 1.068, 95% confidence interval [CI] 1.008 – 1.131, P = 0.025). In Model 2 (adjusted for age, NIHSS score, and DM), mean-SBP (OR = 1.061, 95% CI 1.001 – 1.123, P = 0.045) and max-SBP (OR = 0.951, 95% CI 0.906 – 0.998, P = 0.040) were associated with 3-month mRS score. In Model 3 (adjusted for age, NIHSS score, DM, and infarction location), max-SBP (OR = 0.952, 95% CI 0.906 – 1, P = 0.049) was associated with 3-month mRS score. There was no significant correlation between MAP or DBP and prognosis. Conclusion: Twenty-four-hour BPV parameters (SD/CV/SV/ARV) in patients with AIS undergoing early argatroban therapy were not ideal prognostic predictors of 90-day functional outcomes, but 24-hour max-SBP and mean-SBP showed predictive value. In the future, more prospective studies are needed to further explore the association between short-term BPV and 90-day functional outcomes in patients with AIS undergoing early anticoagulation therapy.