Background/aim: Higher blood pressure (BP) variability (BPV) has been associated with cardiovascular organ damage in cross-sectional studies. Less is known about short-term BPV and organ damage during long-term management of young ischaemic stroke survivors.
Methods: Short-term weighted systolic BPV was assessed from ambulatory 24-hour BP recordings three months after the index stroke in 283 ischaemic stroke survivors aged 15-60 years in the prospective Norwegian Stroke in the young study (NOR-SYS). Organ damage was identified as carotid-femoral pulse wave velocity > 10 m/s, carotid intima-media thickness (cIMT) > 0.9 mm, carotid plaque, and abnormal left ventricular (LV) geometry (LV hypertrophy or concentric LV remodelling). Associations of systolic BPV with organ damage at baseline and after five years were identified in logistic regression analyses.
Results: Weighted systolic BPV was associated with all types of organ damage both at baseline and at 5-year follow-up in univariable analyses. When adjusted for other cardiovascular risk factors, weighted systolic BPV at baseline remained associated with presence of cIMT > 0.9 mm at follow-up (p = 0.03), independent of BP, body mass index and tobacco smoking at follow-up. Associations with all other organ damage outcomes were lost when adjusted for BP in multivariable analysis. In contrast, systolic BP remained associated with all types of organ damage both at baseline and follow-up (all p < 0.05).
Conclusions: In NOR-SYS, the association of higher weighted systolic BPV with cardiac and arterial organ damage was mostly explained by higher systolic BP both at baseline and at 5-year follow-up.
Keywords: 24-hour ambulatory blood pressure recording; Ischaemic stroke; hypertension; secondary prevention; short-time blood pressure variability; target organ damage.
Larger fluctuations in blood pressure levels throughout the day (blood pressure variability) have previously been coupled with an increased risk of heart disease or stroke. We do not know whether blood pressure variability is associated with presence of preclinical disease in the heart or the large arteries (aorta and the carotid arteries) in young adults with ischaemic stroke.This study followed 283 participants for five years. We measured the blood pressure over 24-hours three months after the index stroke, along with studies of the heart and the arteries with ultrasonography and measurement of arterial stiffness with pulse wave velocity. We calculated the blood pressure variability from the 24-hour ambulatory blood pressure recording. After five years the blood pressure and the blood vessels were reassessed.This study showed that systolic blood pressure was a strong risk factor for presence of preclinical disease in the heart and the large arteries, pointing to the importance of controlling blood pressure to preserve a healthy heart and arteries after a stroke. Higher blood pressure variability calculated from the 24-hour blood pressure recording did not provide important additional information beyond blood pressure itself.