Blood pressure variability and early neurological outcomes in acute and subacute stroke in Southwestern Uganda
Background: Greater blood pressure variability has detrimental effects on clinical outcome after a stroke; its effects are controversial and have not been evaluated in Sub-Saharan Africa (SSA). Methods: We conducted a prospective study of patients with CT head confirmed ischemic and hemorrhagic stro...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-12-01
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| Series: | eNeurologicalSci |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405650223000400 |
| _version_ | 1797422580462780416 |
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| author | Nicholas Kulaba Adrian Kayanja Denis Serubiri Mark Kaddu Mukasa Martin Kaddumukasa Jane Nakibuuka Shirley M. Moore Elly T. Katabira Martha Sajatovic Cumara B. O'Carroll Anthony Muyingo |
| author_facet | Nicholas Kulaba Adrian Kayanja Denis Serubiri Mark Kaddu Mukasa Martin Kaddumukasa Jane Nakibuuka Shirley M. Moore Elly T. Katabira Martha Sajatovic Cumara B. O'Carroll Anthony Muyingo |
| author_sort | Nicholas Kulaba |
| collection | DOAJ |
| description | Background: Greater blood pressure variability has detrimental effects on clinical outcome after a stroke; its effects are controversial and have not been evaluated in Sub-Saharan Africa (SSA). Methods: We conducted a prospective study of patients with CT head confirmed ischemic and hemorrhagic strokes admitted to a tertiary hospital within 7 days of onset of unilateral neurological deficits. Blood pressure variability indices, standard deviation (SD) and coefficient of variation (CV) of systolic and diastolic blood pressure between day 0 and day 7, were calculated with a subsequent modified Rankin Scale (mRS) score on day 14 post-stroke. Linear regression was performed to determine the exponential coefficients of mortality at 14 days post- stroke. Results: Out of 120 patients, 51.7% were female, 52.5% had ischemic stroke and the overall median age was 65 (IQR 54–80) years. Twenty (16.7%) patients died within a median survival time of 7 days, while 32 (26.7%) died by day 14 post-stroke. Patients with hemorrhagic stroke had an overall SDSBP of 16.44 mmHg while those with ischemic stroke had an overall SDSBP of 14.05 mmHg. In patients with ischemic stroke, SDSBP had adjusted coefficients of 1, p = 0.004 with C·I: 1.01–1.04 and NIHSS had adjusted coefficients of 1, p = 0.019 with C·I: 1.00–1.03 while in patients with hemorrhagic stroke, SDSBP had adjusted coefficients of 1, p = 0.045 with C·I: 1.00–1.04 and NIHSS had adjusted coefficients of 1, p ≤0.001 with C·I: 1.01–1.03. Conclusion: Exponential increase in Blood Pressure Variability (BPV) and stroke severity scale were independently associated with early mortality among all stroke patients in our study. We recommend future studies to evaluate whether controlling BPV among patients with stroke in Sub-Saharan Africa can reduce mortality. |
| first_indexed | 2024-03-09T07:34:20Z |
| format | Article |
| id | doaj.art-7f627c4ae5d449d78dd466a36c46d30c |
| institution | Directory Open Access Journal |
| issn | 2405-6502 |
| language | English |
| last_indexed | 2024-03-09T07:34:20Z |
| publishDate | 2023-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | eNeurologicalSci |
| spelling | doaj.art-7f627c4ae5d449d78dd466a36c46d30c2023-12-03T05:42:03ZengElseviereNeurologicalSci2405-65022023-12-0133100482Blood pressure variability and early neurological outcomes in acute and subacute stroke in Southwestern UgandaNicholas Kulaba0Adrian Kayanja1Denis Serubiri2Mark Kaddu Mukasa3Martin Kaddumukasa4Jane Nakibuuka5Shirley M. Moore6Elly T. Katabira7Martha Sajatovic8Cumara B. O'Carroll9Anthony Muyingo10Department of Medicine, Mbarara University of Science and Technology, Uganda; Corresponding author.Department of Medicine, Mbarara University of Science and Technology, UgandaDepartment of Medicine, Mbarara University of Science and Technology, UgandaDepartment of Medicine, School of Medicine, College of Health Sciences, Makerere University, UgandaDepartment of Medicine, School of Medicine, College of Health Sciences, Makerere University, UgandaDepartment of Medicine, School of Medicine, College of Health Sciences, Makerere University, UgandaNeurological and Behavioral Outcome Center, University Hospitals Cleveland Medical Center, Case Western Reverse University School of Medicine, 11100 Euclid Avenue, OH 44106, USADepartment of Medicine, School of Medicine, College of Health Sciences, Makerere University, UgandaNeurological and Behavioral Outcome Center, University Hospitals Cleveland Medical Center, Case Western Reverse University School of Medicine, 11100 Euclid Avenue, OH 44106, USADepartment of Neurology, Mayo Clinic College of Medicine and Science, 5777 East Mayo Blvd, Phoenix, AZ 85054, USADepartment of Medicine, Mbarara University of Science and Technology, UgandaBackground: Greater blood pressure variability has detrimental effects on clinical outcome after a stroke; its effects are controversial and have not been evaluated in Sub-Saharan Africa (SSA). Methods: We conducted a prospective study of patients with CT head confirmed ischemic and hemorrhagic strokes admitted to a tertiary hospital within 7 days of onset of unilateral neurological deficits. Blood pressure variability indices, standard deviation (SD) and coefficient of variation (CV) of systolic and diastolic blood pressure between day 0 and day 7, were calculated with a subsequent modified Rankin Scale (mRS) score on day 14 post-stroke. Linear regression was performed to determine the exponential coefficients of mortality at 14 days post- stroke. Results: Out of 120 patients, 51.7% were female, 52.5% had ischemic stroke and the overall median age was 65 (IQR 54–80) years. Twenty (16.7%) patients died within a median survival time of 7 days, while 32 (26.7%) died by day 14 post-stroke. Patients with hemorrhagic stroke had an overall SDSBP of 16.44 mmHg while those with ischemic stroke had an overall SDSBP of 14.05 mmHg. In patients with ischemic stroke, SDSBP had adjusted coefficients of 1, p = 0.004 with C·I: 1.01–1.04 and NIHSS had adjusted coefficients of 1, p = 0.019 with C·I: 1.00–1.03 while in patients with hemorrhagic stroke, SDSBP had adjusted coefficients of 1, p = 0.045 with C·I: 1.00–1.04 and NIHSS had adjusted coefficients of 1, p ≤0.001 with C·I: 1.01–1.03. Conclusion: Exponential increase in Blood Pressure Variability (BPV) and stroke severity scale were independently associated with early mortality among all stroke patients in our study. We recommend future studies to evaluate whether controlling BPV among patients with stroke in Sub-Saharan Africa can reduce mortality.http://www.sciencedirect.com/science/article/pii/S2405650223000400Blood pressure variabilityStrokeOutcomesCerebral infarctionIntracerebral hemorrhageSub-Saharan Africa |
| spellingShingle | Nicholas Kulaba Adrian Kayanja Denis Serubiri Mark Kaddu Mukasa Martin Kaddumukasa Jane Nakibuuka Shirley M. Moore Elly T. Katabira Martha Sajatovic Cumara B. O'Carroll Anthony Muyingo Blood pressure variability and early neurological outcomes in acute and subacute stroke in Southwestern Uganda eNeurologicalSci Blood pressure variability Stroke Outcomes Cerebral infarction Intracerebral hemorrhage Sub-Saharan Africa |
| title | Blood pressure variability and early neurological outcomes in acute and subacute stroke in Southwestern Uganda |
| title_full | Blood pressure variability and early neurological outcomes in acute and subacute stroke in Southwestern Uganda |
| title_fullStr | Blood pressure variability and early neurological outcomes in acute and subacute stroke in Southwestern Uganda |
| title_full_unstemmed | Blood pressure variability and early neurological outcomes in acute and subacute stroke in Southwestern Uganda |
| title_short | Blood pressure variability and early neurological outcomes in acute and subacute stroke in Southwestern Uganda |
| title_sort | blood pressure variability and early neurological outcomes in acute and subacute stroke in southwestern uganda |
| topic | Blood pressure variability Stroke Outcomes Cerebral infarction Intracerebral hemorrhage Sub-Saharan Africa |
| url | http://www.sciencedirect.com/science/article/pii/S2405650223000400 |
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