Blood pressure variability and the risk of post-stroke cognitive impairment following atrial fibrillation related acute ischemic stroke

Background: Blood-pressure variability (BPV) has been associated with adverse outcomes after stroke, but its relevance to post-stroke cognitive impairment (PSCI) remains unclear, particularly in cardioembolic stroke. We investigated the association between acute-phase systolic and diastolic BPV and PSCI in patients with atrial fibrillation-related ischemic stroke. Methods: We conducted a retrospective analysis of a prospective stroke registry including consecutive patients with cardioembolic stroke who underwent standardized neuropsychological assessment at 3 months post-stroke. PSCI was defined as any domain z-score < -2 after adjustment for age, sex, and education. BPV metrics were derived from all systolic and diastolic measurements obtained during the first 7 days of hospitalization. Multivariable logistic regression models adjusted for demographic factors, vascular risk factors, initial National Institutes of Health Stroke Scale (NIHSS) score, and neuroimaging characteristics. Results: Among 143 patients (mean age 70 years; 60.1% male; median NIHSS 5), PSCI occurred in 67 (46.9%). Higher short-term variability in both systolic and diastolic blood pressure (SBP and DBP) was independently associated with PSCI. Each 1-standard deviation (SD) increase in SBP SD conferred an adjusted odds ratio (aOR) of 1.09 (95% confidence interval [CI], 1.01-1.17), and each 1-SD increase in diastolic BP SD an aOR of 1.14 (95% CI, 1.01-1.29). Mean SBP and DBP were also independently associated with PSCI. Conclusions: In patients with cardioembolic stroke, short-term variability in both SBP and DBP during the acute phase was independently associated with PSCI. Acute BPV may represent a modifiable hemodynamic marker of early cognitive vulnerability, warranting further investigation in larger and mechanistic studies.