Blood Pressure Variability and Shifting in Clinical Outcome Amongst Stroke Patients in Southwestern Uganda
Keywords:
Blood pressure variability, Stroke, outcomes, cerebral infarction, intracerebral hemorrhage, Sub-Saharan AfricaAbstract
Background: Higher blood pressure variability has detrimental effects on clinical outcome after a stroke yet it’s has not been well evaluated in Sub-Saharan Africa (SSA). Methods: We conducted a prospective cohort study of CT head confirmed ischemic and hemorrhagic stroke admitted within 7 days of onset of motor weakness. Blood Pressure Variability (BPV) indice; Standard Deviation (SD) of systolic and diastolic Blood pressure (BP) between 0 and 7 days after admission was calculated with subsequent modified Rankin Scale (mRS) score on day 14 and day 30 post-stroke. Ordinal logistic regression was fitted to determine the adjusted odds ratios (aOR) for shifting towards worse clinical outcome among patients with stroke that had survived beyond 14 days with 95% CI and p value<0.05 used as statistical significance. Results: Out of 120 patients, 32 patients passed on by day 14, 88 patients survived beyond day 14. Fifty eight and 15 patients had a zero and 1 point shift in MRS towards worse outcome respectively. Blood pressure variability SD systolic BP tertiles (2&3) had aOR: 1.6, p= 0.306 (95%C.I: 0.6-4.1) and 5.8, p = 0.002 (95%C.I: 1.9-17.5) respectively. NIHSS≥16 had aOR=3.8 (95%CI: 1.5-9.6) P=0.004 and time to presentation ≥ 3 days had aOR=2.8 (95% C.I:1.2-6.3) p=0.013. Conclusion: Higher BPV (tertile 3), late presentation ≥ 3 days and high NIHSS conferred statistically significant odds of shifting towards a bad functional outcome.
Key words: Blood pressure variability; Stroke; outcomes; cerebral infarction; intracerebral hemorrhage; Sub-Saharan Africa
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