Blood Pressure Variability and 90‐Day Functional Outcome in Branch Atheromatous Disease‐Related Stroke: A Multicenter Prospective Study

Branch atheromatous disease (BAD)-related stroke shows distinct prognostic features from other stroke subtypes, with modifiable prognostic factors remaining inconclusive. The present research investigated the association between systolic blood pressure variability (BPV) and 90-day functional outcomes of BAD-related stroke. We enrolled 423 patients (median age 60 years; 70.2% male) with radiologically confirmed BAD from a prospective multicenter study in China. BPV was assessed using standard deviation (SD), coefficient of variation (CV), and variation independent of the mean (VIM) of systolic blood pressure measurements during hospitalization. The primary outcome was a poor functional outcome at 90 days, defined as a modified Rankin Scale (mRS) score >2. The secondary outcome was early neurological deterioration (END) within 7 days. Multivariable logistic regression models were used to evaluate the association between BPV and outcomes. Subgroup and sensitivity analyses were conducted. Overall, 13.9% of patients experienced poor functional outcome. A higher BPV was associated with increased risk of END. Compared with the lowest tertile, patients in the highest tertile of systolic BPV had a significantly increased risk of poor functional outcome (OR: 3.10 for SD, 2.77 for CV, and 2.97 for VIM; all p < 0.05, p for trend <0.05 for all indices). Sensitivity analysis and subgroup analysis results were consistent with the primary findings. In conclusion, elevated systolic BPV during the acute phase is independently associated with END and poor 90-day functional outcome in BAD-related stroke, highlighting the importance of BPV monitoring and blood pressure stabilization in the management of BAD-related stroke.