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Time-variant associations of ambulatory pulse rate with short-term neurologic functional outcomes following acute ischemic stroke

Abstract

This study aims to assess the associations of functional outcomes following acute ischemic stroke (IS) with ambulatory pulse rate (PR) and characterize the time-variant properties of the associations. The prospective cohort consisted of 1831 patients who had ambulatory blood pressure (BP) and PR monitoring following acute IS, and neurologic status evaluated at discharge and 3-month follow-up. The neurologic disability was defined as modified Rankin Scale ≥3. Logistic regression and generalized penalized functional regression models were used to examine the associations of ambulatory BP and PR with neurologic disability. Adjusting for covariates, the neurologic disability at discharge and 3-month was associated with high average 24-h, daytime, and nocturnal PR (odds ratio, OR = 1.20–1.34; p < 0.05 for all), high standard derivation of nocturnal PR (OR = 1.19 and 1.32; p < 0.05 for both), and low nocturnal PR decline (OR = 0.76 and 0.76; p < 0.05 for both). The OR functions of ambulatory PR on neurologic disability were “W-shaped” from 0 a.m. to 12 p.m., with ORs >1 in the wee hours and at noon, and ORs <1 before dawn and at night. The ambulatory BP profiles were not associated with neurologic disability at discharge or 3-month. The ambulatory PR is associated with the risk of short-term neurologic disability of stroke patients, with four different phases in a 24-h cycle. Ambulatory PR monitoring, especially nocturnal PR monitoring, has significant clinical implications for the prevention of short-term neurologic disability in stroke inpatients.

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Fig. 1: Trajectories of ambulatory blood pressure and pulse rate by neurologic status at discharge.
Fig. 2: Odds ratio functions of ambulatory blood pressure and pulse rate profiles on neurologic disability.

Data availability

Data are available upon reasonable request. All data are available to researchers on request for purposes of reproducing the results or replicating the procedure by directly contacting the corresponding author.

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BF, TZ, WC, WL, JX and YW generated the hypothesis and contributed to analytic strategy. BF, WL, TZ and JX extracted the data and performed statistical analyses. BF wrote the manuscript. XH, AC, XM and YW supervised the field activities and data collection. All authors edited the manuscript.

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Correspondence to Tao Zhang or Yongjun Wang.

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Fan, B., Lv, W., Xu, J. et al. Time-variant associations of ambulatory pulse rate with short-term neurologic functional outcomes following acute ischemic stroke. J Hum Hypertens (2022). https://doi.org/10.1038/s41371-022-00763-0

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