J Clin Neurol.  2018 Oct;14(4):555-565. 10.3988/jcn.2018.14.4.555.

Interarm Blood Pressure Difference is Associated with Early Neurological Deterioration, Poor Short-Term Functional Outcome, and Mortality in Noncardioembolic Stroke Patients

• Chang Y
• Kim J
• Kim MH
• Kim YJ
• Song TJ

• KMID: 2424186
• DOI: http://doi.org/10.3988/jcn.2018.14.4.555

Abstract

BACKGROUND AND PURPOSE
Interarm differences in the systolic and diastolic blood pressures (IASBD and IADBD, respectively) are found in various populations, including stroke patients, but their significance for stroke outcomes has rarely been reported. We aimed to determine the associations of IASBD and IADBD with early neurological deterioration (END), functional outcome, and mortality.
METHODS
This study included 1,008 consecutive noncardioembolic cerebral infarction patients who were admitted within 24 hours of onset and had automatic measurements of blood pressures in the bilateral arms. END was assessed within 72 hours of stroke onset according to predefined criteria. A poor functional outcome was defined as a score on the modified Rankin Scale ≥3 at 3 months after the index stroke. All-cause mortality was also investigated during a median follow-up of 24 months. The absolute difference of blood pressure measurements in both arms were used to define IASBD and IADBD.
RESULTS
END occurred in 15.3% (155/1,008) of the patients. A multivariate analysis including sex, age, and variables for which the p value was < 0.1 in a univariate analysis revealed that IASBD ≥10 mm Hg was significantly associated with END [odds ratio (OR)=1.75, 95% CI=1.02-3.01]. IADBD ≥10 mm Hg was also related to END (OR=3.11, 95% CI=1.61-5.99). Moreover, having both IASBD ≥10 mm Hg and IADBD ≥10 mm Hg was related to a poor functional outcome (OR=2.67, 95% CI=1.36-5.35) and mortality (hazard ratio=7.67, 95% CI=3.76-12.83) even after adjusting for END.
CONCLUSIONS
This study suggests that an interarm blood pressure difference of ≥10 mm Hg could be a useful indicator for the risks of END, poor functional outcome, and mortality.

Keyword

interarm blood pressure differences; ankle-brachial index; stroke; early neurological deterioration; functional outcome; mortality

MeSH Terms

Ankle Brachial Index
Arm
Blood Pressure*
Cerebral Infarction
Follow-Up Studies
Humans
Mortality*
Multivariate Analysis
Stroke*

Figure

• 

  Fig. 1 Relationship between END and the IABD according to the IASBD (A) and the IADBD (B). Blue lines and gray shadows indicate the estimated probabilities and 95% CIs, respectively, for the development of END according to IASBD (A) or IADBD (B) based on the generalized additive model with splines. END: early neurological deterioration, IABD: interarm blood pressure difference, IADBD: interarm difference in the diastolic blood pressure, IASBD: interarm difference in the systolic blood pressure.

• 

  Fig. 2 Association of interarm BP difference with early neurological deterioration according to interarm difference in the systolic blood pressure subgroups. Subgroups were divided according to the median values of continuous or ordinal variables. p values are for interactions between subgroups. ABI: ankle-brachial index, BMI: body mass index, BP: blood pressure, HGWMH: high-grade white-matter hyperintensity, NIHSS: National Instititues of Health Stroke Scale.

• 

  Fig. 3 Association of interarm BP difference with early neurological deterioration according to interarm difference in the diastolic blood pressure subgroups. Subgroups were divided according to the median values of continuous or ordinal variables. p values are for interactions between subgroups. ABI: ankle-brachial index, BMI: body mass index, BP: blood pressure, HGWMH: high-grade white-matter hyperintensity, NIHSS: National Instititues of Health Stroke Scale.

• 

  Fig. 4 Kaplan-Meier survival plots of noncardioembolic stroke patients vs. IASBD (A) and IADBD (B). These curves show that the occurrence of all-cause mortality depends on IASBD (p=0.001) (A) and IADBD (p=0.001) (B). IADBD: interarm difference in the diastolic blood pressure, IASBD: interarm difference in the systolic blood pressure.

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