Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

BP Variability Leads to Worse Outcome After Stroke

Stroke; ePub 2018 Jul 16; de Havenon, Majersik, et al

In a secondary analysis of ATACH-2 (Antihypertensive Treatment of Acute Cerebral Hemorrhage II) trial, researchers demonstrate that increased systolic blood pressure variability (BPV) is associated with worse long-term neurological outcome following acute ischemic stroke. The primary outcome of this study was a 3-month follow-up modified Rankin Scale of 3 to 6, and the secondary outcome was a utility-weighted modified Rankin Scale. Researchers calculated blood pressure mean and variability using systolic blood pressure from the acute period (2-24 hours post-randomization) and subacute period (days 2, 3, and 7). The acute period included 913 patients and the subacute included 877. They found:

  • For 5 different statistical measures of systolic BPV, there was a consistent association between increased BPV and worse neurological outcome in both the acute and subacute periods.
  • This association was not found for systolic blood pressure mean.


de Havenon A, Majersik JJ, Stoddard G, et al. Increased blood pressure variability contributes to worse outcome after intracerebral hemorrhage. An analysis of ATACH-2. [Published online ahead of print July 16, 2018]. doi:10.1161/STROKEAHA.118.022133.