Controlling Hypertension and Hypotension Immediately Post Stroke | Journal Scan

Study Questions:

What is the effect of short-term blood pressure variability (BPV) on outcome after acute stroke?


CHHIPS (Controlling Hypertension and Hypotension Immediately Post Stroke) was a trial of BP-lowering after stroke, enrolling 179 acute stroke patients (onset <36 hours). COSSACS (Continue or Stop Post-Stroke Antihypertensives Collaborative Study) compared a strategy of continuation versus temporarily stopping prestroke antihypertensive therapy in 763 acute stroke patients (onset <48 hours). BPV at baseline (defined as SD, coefficient of variation, variation independent of the mean, and average real variability) was derived from standardized casual cuff BP measures (6 readings <30 minutes). Adjusted logistic regression models were used to assess the relation between BPV and death and disability (modified Rankin scale >3) at 2 weeks.


Included in the analysis were 706 (92.5%) and 171 (95.5%) participants for the COSSACS and CHHIPS data sets, respectively. Adjusted logistic regression analyses revealed no statistically significant associations between any of the included BPV parameters with 2-week death or disability in either study data set: COSSACS, odds ratio SD systolic BP 0.98 (0.78–1.23); CHHIPS, odds ratio SD systolic BP 0.97 (0.90–1.11).


The authors concluded that short-term BPV is not a useful predictor of early (2 weeks) outcome after acute stroke.


This study shows no significant association between baseline BPV and the composite outcome of 2-week death or dependency. Although short-term BPV may simply have no effect on outcome, another possible explanation is that casual cuff measures lack the necessary precision to accurately detect short-term BP fluctuations. Furthermore, no BPV increase was seen with use of labetalol in the first 2 weeks after acute stroke, supporting its continued use as a first-line antihypertensive agent in the treatment of elevated BP after acute stroke. Additional prospective studies with more precise detection of BP fluctuations after acute stroke and outcomes are indicated.

Clinical Topics: Prevention, Hypertension

Keywords: Antihypertensive Agents, Blood Pressure, Blood Pressure Determination, Hypertension, Hypotension, Labetalol, Logistic Models, Prospective Studies, Stroke

< Back to Listings