P087 ASSOCIATION OF INTRACRANIAL ARTERIAL STENOSIS WITH LEVEL AND VARIABILITY OF THE HOME BLOOD PRESSURE

Background and Objective: Given the close relation between intracranial arterial stenosis (ICAS) and systolic blood pressure (SBP), this study assessed whether blood pressure variability (BPV) refines risk stratification for ICAS over and beyond SBP using various BPV indexes derived from home blood pressure (BP) monitoring. Methods: In consecutively referred outpatients, all untreated for hypertension, ICAS was assessed by transcranial Doppler ultrasonography. SBP and BPV were determined from 7-day home BP recordings with triplicate readings in the morning and evening. BPV indexes included the standard deviation (SD), the coefficient of variation (CV), variability independent of the mean (VIM), and average real variability (ARV). ICAS probability was assessed with multivariable logistic models and model performance from the area under the curve (AUC). Results: Based on all home readings in 1510 patients, SBP, SD, CV, VIM, and ARV averaged 130.1 mm Hg, 8.36 mm Hg, 6.42%, 8.36, and 6.41 mm Hg. ICAS compared to non-ICAS patients had a similar CV and VIM (P≥0.09), but higher (P≤0.007) SBP, SD, and ARV by 3.9 mmHg, 0.66 mmHg, and 0.54 mmHg, respectively. ICAS was associated with SBP (P<0.001) irrespective of the time of day and with the BPV indexes independent of SBP in all morning readings (P≤0.050), but not in evening readings (P≥0.16). However, the AUC increment only reached significance for ARV in all readings and for CV, VIM, and ARV in morning readings. Conclusions: BPV derived from all-day and morning home BP readings was associated with ICAS independent of SBP but does not substantially refine ICAS risk assessment.