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Title: Blood pressure variability following ischaemic stroke
Author: Davison, William
ISNI:       0000 0004 7973 230X
Awarding Body: University of East Anglia
Current Institution: University of East Anglia
Date of Award: 2019
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Variability in blood pressure (BP) may influence ischaemic stroke outcomes in addition to mean BP. However, how best to measure BP variability (BPV) and whether different measurements are equivalent is unknown, as is whether treatment can reduce BPV. This thesis aimed to investigate relationships between BP and BPV measurements from different devices in patients with ischaemic cerebrovascular disease, relationships between BPV and stroke severity, and whether antihypertensive medications can reduce BPV. Three trials that recruited patients following an ischaemic cerebrovascular event provided data. Correlations and limits of agreement between mean BP and BPV from different measurement devices were assessed. Relationships between baseline BPV and stroke severity were investigated, along with differences in baseline BPV in those treated with calcium channel blockers (CCB) or renin-angiotensin system inhibitors. A feasibility trial was developed to compare the effects of these medication classes on reduction of BPV post stroke. BP from daytime ambulatory monitoring was significantly lower than home BP monitoring and BPV values from different devices were unrelated. There was an inverse relationship between baseline BPV and stroke severity, with BPV increased in lacunar infarction. There was no difference in baseline BPV with the medication regimens specified above. Recruitment to the feasibility trial was insufficient due to patient ineligibility, but a reduction in BPV over three month follow-up was demonstrated. In patients with ischaemic cerebrovascular disease, BP and BPV recorded using different devices are not equivalent. Work to standardise BPV measurement and establish if any method is clinically superior is required. Treatment to reduce BPV may particularly benefit certain stroke patients, yet establishing that it is possible to target BPV, and doing so improves outcomes, is prerequisite. The feasibility trial in this thesis requires modification to be scaled up, but a definitive trial could be successful if recruitment were improved.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available