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. 2022 Jun 21:16:900868.
doi: 10.3389/fnins.2022.900868. eCollection 2022.

The Relationship Between Admission Blood Pressure and Clinical Outcomes for Acute Basilar Artery Occlusion

Yuhong Cao  1 , Rongzong Li  2 , Shunfu Jiang  3 , Jing Guo  4 , Xiaojun Luo  5 , Jian Miao  6 , Jincheng Liu  7 , Bo Zheng  8 , Jie Du  9 , Yuxian Zhang  10 , Shunyu Yang  11 , Li Wang  1 , Wenjie Zi  12 , Qingwu Yang  12 , Jun Luo  13 , Guohui Jiang  1
Affiliations

The Relationship Between Admission Blood Pressure and Clinical Outcomes for Acute Basilar Artery Occlusion

Yuhong Cao et al. Front Neurosci. .

Abstract

Background and purpose: Optimal blood pressure management of patients with basilar artery occlusion (BAO) remains uncertain. This study aimed to investigate the relationship between admission blood pressure and clinical outcomes following acute BAO.

Materials and methods: We analyzed data from a prospective, nationwide cohort study of 829 patients with acute BAO and posterior circulation stroke. Baseline systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded on admission. The primary outcome was neurological functional disability based on the modified Rankin Scale (mRS) score at 90 days. Secondary outcomes included successful reperfusion, mortality within 90 days, and National Institutes of Health Stroke Scale (NIHSS) score change. Multivariable logistic regression was used to assess the associations of SBP and DBP with outcomes.

Results: We include 829 patients with posterior circulation stroke and BAO between January 2014 and May 2019. Multivariate logistic regression showed high SBP and DBP correlated with unfavorable outcomes. The favorable prognosis (mRS ≤ 3) rates of the low-to-normal and the hypertension groups were 34.8 and 23.9%, respectively. After adjusting for covariates, multivariate regression analysis demonstrated that an SBP > 140 mm Hg was associated with a poor functional outcome [adjusted OR (aOR), 1.509; 95% CI, 1.130-2.015] and mortality at 90 days (aOR, 1.447; 95% CI, 1.055-1.985), and predicted a lower probability of successful reperfusion (aOR, 0.550; 95% CI, 0.389-0.778). The risk of symptomatic intracranial hemorrhage and the NIHSS score at 24 h were not significantly different between the high SBP group and the low-to-normal blood pressure group. And the results for DBP were similar.

Conclusion: Among patients with acute BAO, higher systolic or DBP at admission was associated with poor stroke outcomes and had a lower probability of successful reperfusion, with an increased risk of mortality. Trail Registration: [http://www.chictr.org.cn], [ChiCTR1800014759].

Keywords: basilar artery occlusion; blood pressure; functional outcomes; stroke; successful reperfusion.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Distribution of the mRS scores at 90 days in patients with acute basilar artery occlusion according to the dichotomized SBP level. SBP, systolic blood pressure.
FIGURE 2
FIGURE 2
Depiction of (A) the mRS score at 90 days, (B) the probability of a favorable outcome (mRS score 0–3), (C) the probability of 90-day mortality, and (D) the probability of successful reperfusion with 95% confidence intervals for each level of baseline SBP. The ranges of the x-axes correspond to the minimum and maximum values of SBP in the study (SBP: 75–246 mm Hg). Curves show (A) the increases in mRS score at 90 days, (C) an increased probability of 90-day mortality, (B) a decrease in predicted favorable outcome probabilities, and (D) a decrease in the probability of successful reperfusion with an increase in SBP. SBP, systolic blood pressure.
FIGURE 3
FIGURE 3
Depiction of (A) the mRS score at 90 days, (B) the probability of a favorable outcome (mRS score 0–3), (C) the probability of 90-day mortality, and (D) the probability of successful reperfusion with 95% confidence intervals for each level of baseline DBP. The ranges of the x-axes correspond to the minimum and maximum systolic blood pressure values in this study (DBP: 36–150 mm Hg). Curves show the increases in (A) mRS score at 90 days, (C) an increased probability of 90-day mortality, (B) a decrease in predicted favorable outcome probabilities, and (D) a decreased probability of successful reperfusion with increases in DBP. DBP, diastolic blood pressure.
FIGURE 4
FIGURE 4
Association of SBP and DBP with the probability of a favorable outcome at 90 days after basilar artery occlusion. Favorable outcome probability reduces both with increases in SBP and DBP. SBP, systolic blood pressure; DBP, diastolic blood pressure.
FIGURE 5
FIGURE 5
This forest plot shows that the difference in the primary outcome (common odds ratio indicating the odds of deterioration of 1 point on the mRS at 90 days, analyzed with ordinal regression) between two SBP groups (SBP ≥ 140 mm Hg vs. SBP < 140 mm Hg) across all prespecified subgroups. The following variables are considered: hypertension, hyperlipidemia, atrial fibrillation, serum glucose, and stroke causative mechanism. The thresholds for baseline NHISS, baseline pc-ASPECTS, and age were chosen at the median. BA, basilar artery; EVT, endovascular therapy; and IVT, intravenous thrombolysis.
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