Association of blood pressure parameters on early neurological deterioration in patients with mild stroke and large vessel occlusion following medical management

Objective To explore the association between blood pressure (BP) metrics and early neurological deterioration of ischemic origin (ENDi) in patients with mild stroke and large vessel occlusion (LVO) undergoing best medical management (BMM). Methods Data were collected from consecutive patients with mild stroke and LVO treated with BMM from January 2019 to December 2023. Admission systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and 24-h SBP variability were calculated. ENDi was defined as an National Institutes of Health Stroke Scale (NIHSS) score increase of >= 4 points within 24 h, excluding intracranial hemorrhage. Results Among 347 patients, ENDi occurred in 42 (12.1%). The ENDi group exhibited higher admission SBP (158 vs. 131 mmHg, P < 0.001), SBP variability (32 vs. 14 mmHg, P < 0.001), and Tmax > 6 s volumes (63 vs. 40 ml, P < 0.001), and a greater proportion had vertebrobasilar occlusion (42.9% vs. 12.1%, P < 0.001). Multivariable analysis indicated that patients in the highest quartile for admission SBP (adjusted odds ratio [aOR] = 2.47, 95% confidence interval [CI] = 1.47-4.29), SBP variability (aOR = 2.57, 95% CI = 1.34-5.18), and Tmax > 6 s volumes (aOR = 2.09, 95% CI = 1.28-5.89) were independently associated with ENDi. Significant association also existed between vertebrobasilar occlusion and ENDi (aOR = 3.19, 95% CI = 1.76-6.74). Conclusion Significantly elevated admission SBP and large SBP variability were associated with the occurrence of ENDi in patients with mild stroke and LVO receiving BMM.