title: Day-by-Day Blood Pressure Variability and Functional Outcome After Acute Ischemic Stroke: Fukuoka Stroke Registry.
abstract: OBJECTIVE
  The relationship between blood pressure (BP) variability and functional outcome in patients with acute ischemic stroke remains unclear. This study aimed to elucidate whether in-hospital day-by-day BP variability is associated with functional outcome after acute ischemic stroke.
  
  
  METHODS
  Using the Fukuoka Stroke Registry, we included 2566 patients with a first-ever ischemic stroke who had been functionally independent before the onset and were hospitalized within 24 hours. BP was measured daily, and its variability was assessed by SD, coefficients of variance, and variations independent of mean. Poor functional outcome was assessed by modified Rankin Scale scores ≥3 at 3 months.
  
  
  RESULTS
  After adjustment for multiple confounding factors including age, sex, risk factors, stroke features, baseline severity, thrombolytic therapy, antihypertensive agents, and mean BP, day-by-day BP variability during the subacute stage (4-10 days after onset) was independently associated with a poor functional outcome (multivariable-adjusted odds ratios [95% confidence interval] in the top versus bottom quartile of systolic BP variability, 1.51 [1.09-2.08] for SD; 1.63 [1.20-2.22] for coefficients of variance; 1.64 [1.21-2.24] for variations independent of mean). Similar trends were also observed for diastolic BP variability. These trends were unchanged in patients who were not treated with antihypertensive drugs. In contrast, no association was found between indices of BP variability during the acute stage and functional outcome after adjusting for potential confounders.
  
  
  CONCLUSIONS
  These data suggest that intraindividual day-by-day BP variability during the subacute stage is associated with the 3-month functional outcome after acute ischemic stroke.
authors.affiliation: From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (K.F., J.H., T.A., T.K.), Department of Health Care Administration and Management, Graduate School of Medical Sciences (M.K.), and Center for Cohort Studies, Graduate School of Medical Sciences (M.K., J.H., T.K.), Kyushu University, Fukuoka, Japan; Department of Cerebrovascular Disease, St. Mary's Hospital, Kurume, Japan (K.F.); Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine, Kurume, Japan (K.F., H.K., T.I.); Cerebrovascular and Neurology Center, National Hospital Organization Fukuoka-Higashi Medical Center, Koga, Japan (H.N.); and International University of Health and Welfare, Fukuoka Sannou Hospital, Fukuoka, Japan (T.I.).
authors.forename: Kenji
authors.initials: K
authors.lastname: Fukuda
authors.affiliation: From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (K.F., J.H., T.A., T.K.), Department of Health Care Administration and Management, Graduate School of Medical Sciences (M.K.), and Center for Cohort Studies, Graduate School of Medical Sciences (M.K., J.H., T.K.), Kyushu University, Fukuoka, Japan; Department of Cerebrovascular Disease, St. Mary's Hospital, Kurume, Japan (K.F.); Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine, Kurume, Japan (K.F., H.K., T.I.); Cerebrovascular and Neurology Center, National Hospital Organization Fukuoka-Higashi Medical Center, Koga, Japan (H.N.); and International University of Health and Welfare, Fukuoka Sannou Hospital, Fukuoka, Japan (T.I.).
authors.forename: Hisashi
authors.initials: H
authors.lastname: Kai
authors.affiliation: From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (K.F., J.H., T.A., T.K.), Department of Health Care Administration and Management, Graduate School of Medical Sciences (M.K.), and Center for Cohort Studies, Graduate School of Medical Sciences (M.K., J.H., T.K.), Kyushu University, Fukuoka, Japan; Department of Cerebrovascular Disease, St. Mary's Hospital, Kurume, Japan (K.F.); Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine, Kurume, Japan (K.F., H.K., T.I.); Cerebrovascular and Neurology Center, National Hospital Organization Fukuoka-Higashi Medical Center, Koga, Japan (H.N.); and International University of Health and Welfare, Fukuoka Sannou Hospital, Fukuoka, Japan (T.I.). kamouchi@hcam.med.kyushu-u.ac.jp.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kamouchi
authors.affiliation: From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (K.F., J.H., T.A., T.K.), Department of Health Care Administration and Management, Graduate School of Medical Sciences (M.K.), and Center for Cohort Studies, Graduate School of Medical Sciences (M.K., J.H., T.K.), Kyushu University, Fukuoka, Japan; Department of Cerebrovascular Disease, St. Mary's Hospital, Kurume, Japan (K.F.); Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine, Kurume, Japan (K.F., H.K., T.I.); Cerebrovascular and Neurology Center, National Hospital Organization Fukuoka-Higashi Medical Center, Koga, Japan (H.N.); and International University of Health and Welfare, Fukuoka Sannou Hospital, Fukuoka, Japan (T.I.).
authors.forename: Jun
authors.initials: J
authors.lastname: Hata
authors.affiliation: From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (K.F., J.H., T.A., T.K.), Department of Health Care Administration and Management, Graduate School of Medical Sciences (M.K.), and Center for Cohort Studies, Graduate School of Medical Sciences (M.K., J.H., T.K.), Kyushu University, Fukuoka, Japan; Department of Cerebrovascular Disease, St. Mary's Hospital, Kurume, Japan (K.F.); Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine, Kurume, Japan (K.F., H.K., T.I.); Cerebrovascular and Neurology Center, National Hospital Organization Fukuoka-Higashi Medical Center, Koga, Japan (H.N.); and International University of Health and Welfare, Fukuoka Sannou Hospital, Fukuoka, Japan (T.I.).
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Ago
authors.affiliation: From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (K.F., J.H., T.A., T.K.), Department of Health Care Administration and Management, Graduate School of Medical Sciences (M.K.), and Center for Cohort Studies, Graduate School of Medical Sciences (M.K., J.H., T.K.), Kyushu University, Fukuoka, Japan; Department of Cerebrovascular Disease, St. Mary's Hospital, Kurume, Japan (K.F.); Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine, Kurume, Japan (K.F., H.K., T.I.); Cerebrovascular and Neurology Center, National Hospital Organization Fukuoka-Higashi Medical Center, Koga, Japan (H.N.); and International University of Health and Welfare, Fukuoka Sannou Hospital, Fukuoka, Japan (T.I.).
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakane
authors.affiliation: From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (K.F., J.H., T.A., T.K.), Department of Health Care Administration and Management, Graduate School of Medical Sciences (M.K.), and Center for Cohort Studies, Graduate School of Medical Sciences (M.K., J.H., T.K.), Kyushu University, Fukuoka, Japan; Department of Cerebrovascular Disease, St. Mary's Hospital, Kurume, Japan (K.F.); Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine, Kurume, Japan (K.F., H.K., T.I.); Cerebrovascular and Neurology Center, National Hospital Organization Fukuoka-Higashi Medical Center, Koga, Japan (H.N.); and International University of Health and Welfare, Fukuoka Sannou Hospital, Fukuoka, Japan (T.I.).
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Imaizumi
authors.affiliation: From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (K.F., J.H., T.A., T.K.), Department of Health Care Administration and Management, Graduate School of Medical Sciences (M.K.), and Center for Cohort Studies, Graduate School of Medical Sciences (M.K., J.H., T.K.), Kyushu University, Fukuoka, Japan; Department of Cerebrovascular Disease, St. Mary's Hospital, Kurume, Japan (K.F.); Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine, Kurume, Japan (K.F., H.K., T.I.); Cerebrovascular and Neurology Center, National Hospital Organization Fukuoka-Higashi Medical Center, Koga, Japan (H.N.); and International University of Health and Welfare, Fukuoka Sannou Hospital, Fukuoka, Japan (T.I.).
authors.forename: Takanari
authors.initials: T
authors.lastname: Kitazono
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology; D001795:Blood Pressure Determination / Q000379:methods / Q000592:standards; D002545:Brain Ischemia / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D013997:Time Factors; D016896:Treatment Outcome
keywords: blood pressure; cerebral infarction; prognosis; risk factors; stroke