Russell Mitesh Cerejo, MD 

Manning LS, Rothwell PM, Potter JF, and Robinson TG. Prognostic Significance of Short-Term Blood Pressure Variability in Acute Stroke: Systematic Review. Stroke. 2015 

Appropriate management of blood pressure in acute stroke has always a moving target. In a meta-analysis of 18 studies, Dr. Manning and her group evaluated the effect of blood pressure variability within the first seven days after a stoke on short and long term outcomes. None of the studies were randomized controlled trials (RCT) but seven studies were of a prospective observational nature, five were observational analyses of prospective stroke registry data and six were observational analyses of previous RCT data. Seven studies were deemed suitable for the final meta-analysis of blood pressure variability on functional outcome. 

The group found that greater variability in blood pressure early after acute stroke might be associated with an increased risk of death and disability. Early on, systolic blood pressure variation was also associated with hemorrhagic complications after thrombolysis. However no effect was seen on short-term functional or neurological outcomes.

There was considerable heterogeneity in the studies that were reviewed by the group. The authors stress the importance of standardized practice for reporting of blood pressure measurements, blood pressure medications and timing with respect to the stroke onset. This will help draw robust conclusion in the future with regards to blood pressure management in acute stroke care.