AUTHOR=Filchenko Irina , Mürner Nicolas , Dekkers Martijn P. J. , Baillieul Sebastien , Duss Simone B. , Brill Anne-Kathrin , Horvath Thomas , Heldner Mirjam R. , Rexhaj Emrush , Bernasconi Corrado , Bassetti Claudio L. A. , Schmidt Markus H. 

TITLE=Blood pressure variability, nocturnal heart rate variability and endothelial function predict recurrent cerebro-cardiovascular events following ischemic stroke

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1288109

DOI=10.3389/fcvm.2023.1288109

ISSN=2297-055X

ABSTRACT=Introduction
Cardiovascular parameters characterizing blood pressure (BP), heart rate (HR), endothelial function and arterial stiffness predict CCVE in the general population. Considering the paucity of data in stroke patients, we assessed these parameters as potential predictors of recurrent CCVE in acute stroke and at 3 months post-stroke.
Patients and methods
This is a secondary outcome analysis of a prospective observational longitudinal Sleep Deficiency & Stroke Outcome Study (ClinicalTrials.gov Identifier: NCT02559739). The study consecutively recruited acute ischemic stroke patients. Cardiovascular parameters were assessed within the first week post-stroke. Future CCVE were recorded over a 3-year follow-up. Multivariate Cox regression analysis was used to investigate the prognostic value of 48 cardiovascular parameters regarding CCVE risk.
Results
Out of 447 recruited patients, 359 were included in this analysis. 20% of patients developed a future CCVE. A high variability of systolic BP (n=333) and nocturnal HR (non-linear parameters; n=187) at acute stroke predicted CCVE risk after adjustment for demographic parameters, cardiovascular risk factors and mean BP or HR, respectively. Endothelial dysfunction (n=105) at acute stroke predicted CCVE risk after adjustment for age and sex, but not after adjustment for cardiovascular risk factors. Diurnal HR and arterial stiffness at acute stroke were not associated with CCVE risk. 
Conclusion
High blood pressure variability, high nocturnal HRV and endothelial function contribute to the risk for future CCVE after stroke.