Beat-to-Beat Blood Pressure Variability Predicts Recurrent Stroke, Cardiovascular Events

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Day-to-day BPV was not as strongly associated with risk for stroke, but was comparably associated with the risk for cardiovascular events.

Beat-to-beat blood pressure variability (BPV) is a novel way to predict risk for recurrent stroke and cardiovascular events, according to the results of a study published in Stroke.

Among 405 patients who underwent all types of monitoring, beat-to-beat BPV was predictive of recurrent stroke (before age/gender adjustment: hazard ratio [HR] 1.47; 95% CI, 1.12-1.91; P =.005; after: HR 1.47; 95% CI, 1.12-1.92; P =.005) and cardiovascular events (before: HR 1.41; 95% CI, 1.08-1.83; P =.01; after: HR 1.40; 95% CI, 1.00-1.94; P =.047).

Day-to-day BPV was not as strongly associated with risk for stroke (adjusted HR 1.29; 95% CI, 0.97-1.71; P =.08) but was comparably associated with risk for cardiovascular events (HR 1.41; 95% CI, 1.09-1.83; P =.009). Beat-to-beat BPV was significantly associated with risk for recurrent stroke independent of day-to-day BPV (HR 1.41; 95% CI, 1.05-1.90; P =.02).

The HR per 1% increase in beat-to-beat coefficient of variation for stroke was 1.24 (95% CI, 1.07-1.43; P = .004). A significant increase was reported in the absolute risk for recurrent stroke and all cardiovascular events across quartiles of BPV. Moreover, beat-to-beat and day-to-day BPV were both moderately reproducible in 50 patients and 100 patients, respectively (P <.001 for each).

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The investigators concluded that the “…study shows that a rapid, 5-minute assessment of beat-to-beat BPV may have similar prognostic significance compared with HBPM [home blood pressure monitoring].” Thus, beat-to-beat BPV may be beneficial in risk stratification and may help identify independently treatable mechanisms for reducing a person’s risk for stroke and cardiovascular events.


Webb AJS, Mazzucco S, Li L, Rothwell PM. Prognostic significance of blood pressure variability on beat-to-beat monitoring after transient ischemic attack and stroke. Stroke. 2018;49(1):62-67.