Association between High-Sensitivity C-Reactive Protein and Blood Pressure Variability in Subacute Stage of Ischemic Stroke

Q: What are the key findings of this study?

Elevated hsCRP (≥2 mg/L) was independently associated with higher 24-hour systolic blood pressure variability (SD β 2.29, 95% CI 1.55-3.04) in subacute ischemic stroke.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Subacute stage of acute ischemic stroke (n=325). Intervention: Elevated circulating high-sensitivity C-reactive protein (hsCRP ≥ 2 mg/L) vs. Lower circulating high-sensitivity C-reactive protein (hsCRP < 2 mg/L) or lowest hsCRP quartile. Primary outcome: 24-hour systolic blood pressure variability (standard deviation [SD] of 24 h SBP) (β 2.29, 95% CI 1.55-3.04).

Q: What does this research mean for the field?

Elevated high-sensitivity C-reactive protein (hsCRP ≥ 2 mg/L) is dose-dependently and independently associated with increased 24-hour blood pressure variability in patients during the subacute stage of ischemic stroke. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Chuanli Xu; Zhiyong Fu; Wei Wu; Jin Zhang; Meitong Liu; Lianbo Gao

doi:10.3390/brainsci13070998

June 28, 2023Brain SciencesOpen Access

Association between High-Sensitivity C-Reactive Protein and Blood Pressure Variability in Subacute Stage of Ischemic Stroke

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Key result

Elevated hsCRP links to higher 24-hour systolic blood pressure variability in subacute ischemic stroke.

β +2.29
95% CI 1.55-3.04
n=325

Figures

Why the study?

Determinants of blood pressure variability (BPV) are complex, and whether circulating hsCRP is associated with short-term BPV during the subacute stage of ischemic stroke was unknown.

Is elevated circulating high-sensitivity C-reactive protein (hsCRP) associated with increased short-term 24-hour blood pressure variability during the subacute stage of acute ischemic stroke?

Key Points

To evaluate whether circulating high-sensitivity C-reactive protein (hsCRP) is associated with short-term blood pressure variability during the subacute stage of ischemic stroke.
Conducted an observational study in 325 acute ischemic stroke patients (mean age 60.0 years, 72% male) who underwent 24 h ambulatory blood pressure monitoring between days 4 and 10 after symptom onset.
Used multivariable linear regression models adjusted for clinical covariates, vascular risk factors, stroke severity, and lesion patterns to analyze the relationship between hsCRP levels and blood pressure variability indices.
Higher hsCRP (≥ 2 mg/L) was significantly associated with greater systolic blood pressure variability across SD (β, 2.29 [95% CI 1.55–3.04]), CV (β, 1.21 [95% CI 0.72–1.71]), and ARV (β, 1.9 [95% CI 1.24–2.56]).
hsCRP was also significantly associated with diastolic blood pressure variability for SD (β, 0.93 [95% CI 0.41–1.46]), CV (β, 1.12 [95% CI 0.44–1.80]), and ARV (β, 0.93 [95% CI 0.45–1.41]), demonstrating a dose-response relationship across hsCRP quartiles.
Adjusted regression showed a significant association between hsCRP and mean systolic blood pressure (β, 6.94 [95% CI 3.39–10.48]), but no significant association with mean diastolic blood pressure (β, 0.99 [95% CI −1.29–3.27]).

Study Design

Type

Cross-Sectional (n=325)

Blinding

Blinded evaluation of lesion distribution and central laboratory hsCRP testing

Multicenter

No

Structured PICO

Is elevated circulating high-sensitivity C-reactive protein (hsCRP) associated with increased short-term 24-hour blood pressure variability during the subacute stage of acute ischemic stroke?

P

Population

325 adults (mean age 60.0 years, 28% female) in the subacute phase of acute ischemic stroke (days 4-10 post-onset) without kidney dysfunction, infection, or malignancy, evaluated over 24 hours.

E

Exposure

Elevated circulating high-sensitivity C-reactive protein (hsCRP ≥ 2 mg/L and across quartiles) measured within 24 h after hospitalization

C

Comparator

Lower circulating hsCRP (< 2 mg/L, or lowest quartile of hsCRP as reference category)

O

Outcome

Short-term (24-hour) blood pressure variability (BPV) during the subacute stage (days 4-10 post-onset), assessed by standard deviation (SD), coefficient of variation (CV), and average real variability (ARV) of 24 h systolic blood pressure (SBP) and diastolic blood pressure (DBP) via 24 h ambulatory blood pressure monitoring (ABPM)surrogate

Main Result

Mean Difference: 2.29 (95% CI 1.55–3.04)

Circulating hsCRP is independently and dose-dependently associated with higher 24-hour blood pressure variability during the subacute stage of ischemic stroke, linking systemic inflammation to short-term blood pressure fluctuations.

Limitations

Observational single-center cross-sectional study with potential selection bias.
Neurological deficits of included patients were relatively minor (median initial NIHSS score was 2).
Serum inflammatory markers were only measured once within 24 hours of admission, whereas 24 h ABPM was performed on days 4 to 10 after onset.
Antihypertensive medications were empirically given to 28.3% of patients, which may have affected the relationship between hsCRP and BPV despite statistical adjustment.
Observational study design with potential unavoidable selection bias
Relatively minor neurological deficits in the cohort (median NIHSS at admission was 2 points)
Serum inflammatory markers were not tracked over time (blood drawn within 24 h of admission while ABPM occurred days 4 to 10 after onset)
Empirical use of antihypertensive medications in 28.3% of patients may have confounded the relationship between hsCRP and BPV

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Implication

Hypothesis-generating for inflammation-BPV link in subacute stroke; prospective trials needed before clinical adoption.

Abstract

The determinants of blood pressure variability (BPV) are complex. We aimed to evaluate whether circulating high-sensitivity C-reactive protein (hsCRP) is associated with short-term BPV during the subacute stage of ischemic stroke. In this observational study, a consecutive series of acute ischemic stroke patients who underwent 24 h ambulator blood pressure monitoring (ABPM) during day 4 to 10 after onset were enrolled. Multivariable linear regression models were constructed to assess relationships between hsCRP and BPV. Among a total of 325 patients analyzed, the mean age was 60 years old and 72% were male. The SD, CV, ARV of 24 h SBP and DBP were more likely to be higher in patients with hsCRP ≥ 2 mg/L, and these predispositions remained unchanged in linear regression analyses after adjusting for possible confounding factors, with a dose-response relationship when patients were additionally categorized into quartiles according to hsCRP levels using the lowest quartile as a reference category. In contrast, similar results were observed for the mean of SBP but not the mean of DBP. These results indicate that hsCRP is dose-dependently associated with short-term BPV during the subacute stage of ischemic stroke. These findings suggested that patients with a higher level of hsCRP tended to have larger blood pressure fluctuations.

Discussion

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Cite This Study

Xu et al. (2023) conducted a cross-sectional in Subacute stage of acute ischemic stroke (n=325). Elevated circulating high-sensitivity C-reactive protein (hsCRP ≥ 2 mg/L) vs. Lower circulating high-sensitivity C-reactive protein (hsCRP < 2 mg/L) or lowest hsCRP quartile was evaluated on 24-hour systolic blood pressure variability (standard deviation [SD] of 24 h SBP) (β 2.29, 95% CI 1.55-3.04). Elevated hsCRP (≥2 mg/L) was independently associated with higher 24-hour systolic blood pressure variability (SD β 2.29, 95% CI 1.55-3.04) in subacute ischemic stroke.

synapsesocial.com/papers/6a75ca055cab3f3f2119c9a0 https://doi.org/10.3390/brainsci13070998

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Association between High-Sensitivity C-Reactive Protein and Blood Pressure Variability in Subacute Stage of Ischemic Stroke

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Association between High-Sensitivity C-Reactive Protein and Blood Pressure Variability in Subacute Stage of Ischemic Stroke

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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