Early wide systolic pressure excursion is associated with clinical outcomes in acute branch atheromatous disease

Zhong Yao¹Zhong Fu^2,3*Lanying He^4*YingLin Liu⁴Jian Wang⁴Lun Luo⁴

• ¹Chengdu Medical College, Chengdu Second People's Hospital, Chengdu, China
• ²Jianyang Hospital of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
• ³Department of Neurology, The People's Hospital of Jianyang City, Jianyang, China
• ⁴Chengdu Second People's Hospital, Chengdu, China

Objectives—Acute branch atheromatous disease (BAD) is frequently associated with early neurological deterioration (END), a significant predictor of adverse clinical outcomes. The present study aimed to investigate the relationship between early substantial fluctuations in blood pressure (BP) and both 72-hour END and 3-month clinical outcomes in patients diagnosed with acute BAD. Methods—This investigation included a cohort of 241 patients (mean age 66.10 ± 11.31 years) diagnosed with acute BAD, all of whom underwent a thorough clinical assessment and continuous blood pressure monitoring. Both maximum and minimum BP levels were systematically recorded during the 72 hours following the onset of neurological symptoms. END was identified as an increase in the NIHSS score of 2 or more points within 72 hours post-stroke onset. Results—23.65% (57/241) of patients underwent END, 78.42% (189/241) of patients had favorable clinical outcomes. Patients who experienced END exhibited a significantly wider SP excursion compared to those without END (P=0.031). In fully adjusted models, after adjusting for potential confounders, no significant association was observed between wide SP excursions and END (P=0.535). Wide SP excursions were associated with poor prognosis at 3 months in adjusted models (P<0.05). Conclusions—Wider SP excursions were independently associated with an elevated risk of poor clinical outcomes in patients with BAD. These findings suggest that excessive fluctuations in early systolic pressure should be minimized during the first 72 hours following the onset of symptoms in individuals with acute BAD.