Key result
Long-term SBP variability linked to ~82% higher risk of recurrent ICH, ischemic stroke, and MI.
Why the study?
Survivors of ICH are at increased risk for MACCE, but whether long-term blood pressure variability is an independent risk factor was unknown.
Does long-term blood pressure variability increase the risk of major adverse cardiovascular and cerebrovascular events in survivors of intracerebral hemorrhage?
Cohort (n=1,828)
Yes
Does long-term blood pressure variability increase the risk of major adverse cardiovascular and cerebrovascular events in survivors of intracerebral hemorrhage?
Long-term systolic blood pressure variability is a potent, independent risk factor for recurrent hemorrhage, ischemic stroke, and myocardial infarction in survivors of intracerebral hemorrhage, highlighting the need for consistent blood pressure control.
Answers are grounded in this paper and cite their sources.
May flag higher-risk ICH survivors for monitoring; leaves open whether variability-targeted BP strategies improve outcomes.
Background Survivors of intracranial hemorrhage (ICH) are at increased risk for major adverse cardiovascular and cerebrovascular events (MACCE), in the form of recurrent stroke and myocardial Infarction. We investigated whether long-term blood pressure (BP) variability represents a risk factor for MACCE after ICH, independent of average BP. Methods and Results We analyzed data from prospective ICH cohort studies at Massachusetts General Hospital and the University of Hong Kong. We captured long-term (ie, visit-to-visit) BP variability, quantified as individual participants' variation coefficient. We explored determinants of systolic and diastolic BP variability and generated survival analyses models to explore their association with MACCE. Among 1828 survivors of ICH followed for a median of 46.2 months we identified 166 with recurrent ICH, 68 with ischemic strokes, and 69 with myocardial infarction. Black (coefficient +3.8, SE 1.3) and Asian (coefficient +2.2, SE 0.4) participants displayed higher BP variability. Long-term systolic BP variability was independently associated with recurrent ICH (subhazard ratio [SHR], 1.82; 95% CI, 1.19-2.79), ischemic stroke (SHR, 1.62; 95% CI, 1.06-2.47), and myocardial infarction (SHR, 1.54; 95% CI, 1.05-2.24). Average BP during follow-up did not modify the association between long-term systolic BP variability and MACCE. Conclusions Long-term BP variability is a potent risk factor for recurrent hemorrhage, ischemic stroke, and myocardial infarction after ICH, even among survivors with well-controlled hypertension. Our findings support the hypothesis that combined control of average BP and its variability after ICH is required to minimize incidence of MACCE.
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Castello et al. (2022) conducted a cohort in Intracerebral Hemorrhage (n=1,828). Long-term blood pressure variability was evaluated on Recurrent intracerebral hemorrhage (SHR 1.82, 95% CI 1.19-2.79). Long-term systolic blood pressure variability was independently associated with recurrent intracerebral hemorrhage (SHR 1.82; 95% CI 1.19-2.79), ischemic stroke, and myocardial infarction.
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