Abstract DP382: Increased blood pressure variability over the first 24 hours of admission is independently associated with neurological deterioration among patients with acute ischemic stroke

Background: Neurological deterioration (ND) among acute ischemic stroke (AIS) patients contributes to poor outcomes and increased mortality. With hypertension appearing as a risk factor for ND, other cardiovascular factors, including systolic Blood Pressure Variability (sBPV) during the first 24 hours of admission, may provide advanced warning of ND and present a target for intervention. We assess the odds of ND associated with 24-hour sBPV during AIS admission. Methods: Data was collected for patients admitted with acute ischemic stroke (AIS) between May 2016 and August 2025 from the Registry of Neurological Endpoint Assessment among patients with Ischemic and Hemorrhagic Stroke (REINAH), including demographics, comorbidities, NIHSS outcomes, and blood pressure measurements during the first 24 hours of admission. Patient ND was assessed as an increase in NIHSS score of >4 points across hospital admission, and sBPV was measured using the coefficient of variation (CV; 100*standard deviation/mean). Differences in sBPV across outcome were assessed using Wilcoxon Rank Sum tests. Logistic regression models were fit to evaluate the univariable and multivariable associations between sBPV and ND. Results are reported as medians and Interquartile Ranges (IQRs), with odds ratios (ORs) and 95% confidence intervals (CIs). Results: Data was collected for 19899 AIS patients (median age: 69 [60-79]; 10160 (51.1%) Female; 3175 (16.0%) Hispanic,1075 (5.4%) Asian, 5080 (25.5%) Black, 10186 (51.2%) White, 383 (1.9%) Other). In total, patients had a median sBPV of 10.17 [7.40-13.58] and 1675 (8.42%) exhibited ND. Patients with ND had significantly higher sBPV than those who did not (11.17 [8.20-15.06] vs. 10.07 [7.34-13.44]; p<0.001). In univariate analysis, higher quartiles of sBPV were associated with higher ND in patients with AIS (2 nd quartile: 1.21 [1.04-1.42], p=0.015; 3 rd quartile: 1.48 [1.28-1.73], p<0.001; 4 th quartile: 1.85 [1.60-2.14], p<0.001; vs 1 st quartile). After adjusting for major clinical covariates, the association remained significant for all quartiles (2nd quartile: 1.24 [1.05-1.45], p=0.012; 3 rd quartile: 1.41 [1.20-1.64], p<0.001; and 4 th quartile: 1.57 [1.35-1.83], p<0.001) (Figure 1). Discussion: Systolic blood pressure variability (sBPV) during the first 24 hours of admission was independently associated with development of neurological deterioration (ND) in patients with acute ischemic stroke (AIS), even after accounting for major clinical covariates.