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Abstract
Blood pressure variability, the variation of blood pressure during a certain period, results from the interaction of hemodynamic, neuronal, humoral, behavioral, and environmental factors. Cerebral autoregulation is impaired in acute cerebrovascular disease. Hence, increased blood pressure variability (BPV) may provoke or exacerbate secondary brain injury. In fact, available data showed that increased blood pressure variability is associated with worse outcomes after acute ischemic stroke, intracerebral hemorrhage, and aneurysmal subarachnoid hemorrhage. Consequently, BPV may represent a usual modifiable therapeutic target. This concept is particularly attractive because reduction of BPV can be feasible in regions with lower resources and can be applicable to patients with various forms of acute stroke. Prospective studies are needed to further clarify the relationship between BPV and secondary brain damage and the determinants of BPV in different clinical populations. Ultimately, cerebrovascular disease–specific randomized controlled trials aimed at reducing BPV, irrespective of the absolute blood pressure values, are needed to determine whether reduction of BPV can improve outcomes in patients with acute cerebrovascular disease.
Glossary
- ATACH-II=
- second Antihypertensive Treatment of Acute Cerebral Haemorrhage II;
- BPV=
- blood pressure variability;
- CHHIPS=
- Controlling Hypertension and Hypotension Immediately Post-Stroke;
- COSSACS=
- Continue or Stop Post-Stroke Antihypertensives Collaborative Study;
- ESO=
- European Stroke Organisation;
- INTERACT2=
- second Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial;
- mRS=
- modified Rankin Scale;
- rt-PA=
- recombinant tissue plasminogen activator;
- TICI=
- Thrombolysis In Cerebral Infarction
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Submitted and externally peer reviewed. The handling editor was Brad Worrall, MD, MSc, FAAN.
- Received December 20, 2021.
- Accepted in final form April 29, 2022.
- © 2022 American Academy of Neurology
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