title: Visit-to-visit systolic blood pressure variability predicts all-cause and cardiovascular mortality after lacunar infarct.
abstract: OBJECTIVE
  Both blood pressure (BP) and its variability (BPV) are established risk factors for development of atherosclerotic disease and are associated with an increased risk for cardiovascular and all-cause mortality. The prognostic implications of outpatient clinic visit-to-visit BPV amongst patients with lacunar infarction are nevertheless unknown.
  
  
  METHODS
  The clinical outcome of 281 patients with lacunar infarction was prospectively followed up. The average BP and BPV, as determined by the standard deviation of the systolic and diastolic BP, were recorded during a mean 13 ± 6 outpatient clinic visits.
  
  
  RESULTS
  The mean age of the population was 70 ± 10 years. After a mean 78 ± 18 months follow-up, 65 patients died (23%), 31% (20/65) due to cardiovascular causes; 14% and 7% developed recurrent stroke and acute coronary syndrome. After adjusting for age, sex, mean systolic and diastolic BP, cardiovascular risk factors and comorbidities, patients with a systolic BPV of the third tertile had significantly higher risk of all-cause mortality [hazard ratio (HR) 1.97, 95% confidence interval (CI) 1.02-3.80, P = 0.04) and cardiovascular mortality (HR 7.64, 95% CI 1.65-35.41, P < 0.01) than those with systolic BPV of the first tertile. Nevertheless, systolic BPV did not predict recurrent stroke or acute coronary syndrome. Diastolic BPV did not predict various adverse clinical outcomes.
  
  
  CONCLUSIONS
  Visit-to-visit systolic BPV predicts long-term all-cause and cardiovascular mortality after lacunar infarct, independent of conventional risk factors including average BP control.
authors.affiliation: Neurology Division, Department of Medicine, University of Hong Kong, Hong Kong, China.
authors.forename: K K
authors.initials: KK
authors.lastname: Lau
authors.forename: Y K
authors.initials: YK
authors.lastname: Wong
authors.forename: R S K
authors.initials: RS
authors.lastname: Chang
authors.forename: K C
authors.initials: KC
authors.lastname: Teo
authors.forename: S F K
authors.initials: SF
authors.lastname: Hon
authors.forename: K H
authors.initials: KH
authors.lastname: Chan
authors.forename: K L
authors.initials: KL
authors.lastname: Wat
authors.forename: R T F
authors.initials: RT
authors.lastname: Cheung
authors.forename: L S W
authors.initials: LS
authors.lastname: Li
authors.forename: C W
authors.initials: CW
authors.lastname: Siu
authors.forename: S L
authors.initials: SL
authors.lastname: Ho
authors.forename: H F
authors.initials: HF
authors.lastname: Tse
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000503:physiopathology; D002423:Cause of Death; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D059409:Stroke, Lacunar / Q000401:mortality* / Q000503:physiopathology
keywords: blood pressure variability; lacunar infarct; mortality