Blood Pressure Variability And Shifting In Clinical Outcome Amongst Stroke Patients Admitted To Mbarara Regional Referral Hospital.

Abstract

Background: Greater blood pressure variability can have detrimental effects on clinical outcome after a stroke and it’s has not been 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) indices; Standard Deviation (SD) and coefficient of variation (CV) of systolic and diastolic Blood pressure (BP) between 0 and 7 days after admission were 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 bad functional 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, 31 patients passed on by day 14, 89 patients survived beyond day 14. 58 and 15 patients had a zero and 1 point shift in MRS towards bad outcome respectively. 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. CV systolic BP tertiles (3&2) had aOR=2.9, p= 0.045 (95% CI: 1.0 – 8.3) and 1.4, p= 0.615 (95% CI: 0.4 - 4.5) 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: High BPV (SDSBP & CVSBP tertile 3), late presentation ≥ 3 days and high NIHSS conferred statistically significant odds of shifting towards a bad functional outcome.