Early wide systolic pressure excursion is associated with clinical outcomes in acute branch atheromatous disease

Objectives Acute branch atheromatous disease (BAD) is frequently associated with early neurological deterioration (END), which is a significant predictor of poor clinical outcomes. The present study aimed to investigate the relationship between early substantial fluctuations in blood pressure (BP) and both 72-h END and 3-month clinical outcomes in patients diagnosed with acute BAD. Methods This investigation included a cohort of 241 patients (mean age 66.10 ± 11.31 years) diagnosed with acute BAD, all of whom underwent comprehensive clinical assessment and continuous blood pressure monitoring. Both maximum and minimum BP levels were systematically recorded during the 72 h following the onset of neurological symptoms. END was defined as an increase of 2 or more points in the National Institutes of Health Stroke Scale (NIHSS) score within 72 h after the onset of stroke. Results The results revealed that 23.65% (57/241) of the patients experienced END, while 78.42% (189/241) had favorable clinical outcomes. The patients who experienced END exhibited significantly wider systolic pressure (SP) excursions compared to those without END ( p = 0.031). In fully adjusted models, after adjusting for potential confounders, no significant association was observed between wide SP excursions and END ( p = 0.535). Wide SP excursions were associated with a poor prognosis at 3 months in the adjusted models ( p < 0.05). Conclusion Wider SP excursions were independently associated with an elevated risk of poor clinical outcomes in patients with BAD. These findings suggest that excessive fluctuations in early systolic pressure should be controlled during the first 72 h following symptom onset in individuals with acute BAD.