UNASSIGNED: The cardiovascular risk of Parkinson\'s Disease (PD) patients is uncertain. Blood pressure variability (BPV) has been associated with cardiovascular and mortality outcomes. We aimed to evaluate blood pressure variability, as a marker of cardiovascular risk, in patients with PD and matched community controls.
UNASSIGNED: Cross-sectional case-control study was performed. All subjects included in the analysis were clinically evaluated and performed a 24 h ambulatory blood pressure monitoring. BPV was assessed using standard deviations (SDs) of the systolic blood pressure (SBP) and diastolic blood pressure (DBP) for each period - 24 h, daytime, and night-time.
UNASSIGNED: The study included 204 participants, 102 in each group. Mean age 66 years old and 59% man. Most PD patients presented mild symptoms (mean Hoehn&Yahr 2.04). Daytime BPV was significantly higher in PD patients (SD SBP 14.1 mmHg vs 12.96 mmHg and SD DBP 9.39 mmHg vs 8.29 mmHg), but 24 h and night-time BPV were non-significantly increased. PD patients present non-significant higher night-time SBP (114 mmHg vs 110 mmHg) as well as higher frequency of non-dippers or reverse dippers BP profiles (51% vs 36%).
UNASSIGNED: Our exploratory study suggests that PD patients may present a higher blood pressure variability, which may translate in an increased cardiovascular risk. However, further studies are needed to confirm this hypothesis and causality.

BACKGROUND: Autonomic dysfunctions including bladder dysfunction, gastrointestinal dysfunction and orthostasis are common symptoms of autoimmune glial fibrillary acidic protein astrocytopathy (A-GFAP-A); however, cardiac autonomic dysfunction and abnormal circadian rhythm of blood pressure, which can lead to poor prognosis and even sudden cardiac death, has never been reported in A-GFAP-A patient.
METHODS: A 68-year-old male Chinese patient presented to our hospital with headache, fever, progressive disturbance of consciousness, dysuria, and limb weakness. Abnormal heart rate variability and non-dipper circadian rhythm of blood pressure gradually developed during hospitalization, which is rare in A-GFAP-A. He had positive GFAP IgG in cerebrospinal fluid (CSF). Enhanced brian MRI showed uneven enhancement and T2 hyperintense lesions of medulla oblongata; Cervical spine MRI showed T2 hyperintense lesions in medulla oblongata and upper margin of the T2 vertebral body. A contrast-enhanced thoracic spine MRI showed uneven enhancement and T2 hyperintense lesions of T1 to T6 vertebral segments. After treatment with intravenous immunoglobulin and corticosteroids, the patient\'s symptoms, including autonomic dysfunction, alleviated dramatically. Finally, his heart rate variability and blood pressure variability became normal.
CONCLUSIONS: Our case broadens the spectrum of expected symptoms in A-GFAP- A syndromes as it presented with heart rate variability and blood pressure variability.

BACKGROUND: This study aims to assess the association of postoperative stroke with intraoperative hemodynamic variability and transfusion management.
METHODS: In this case-control study, adult patients (≥ 18 years) who had a stroke within 72 hours of a surgical procedure were matched to 2 control patients according to age, sex, and procedure type. Primary risk factors assessed were intraoperative fluid administration, blood product transfusion, vasopressor use, and measures of variability in systolic and diastolic blood pressure and heart rate: maximum, minimum, range, SD, and average real variability. The variables were analyzed with conditional logistic regression, which accounted for the 1:2 matched case-control study design.
RESULTS: Among 687 581 procedures, we identified 64 postoperative strokes (incidence, 9.3 [95% CI, 7.2-11.9] strokes per 100 000 procedures). These cases were matched with 128 controls. Stroke cases had higher Charlson cmorbidity index scores than did controls (P = .046). Blood pressure and heart rate variability measures were not associated with stroke. The risk of stroke was increased with red blood cell (RBC) transfusion (odds ratio [OR], 14.82; 95% CI, 3.40-64.66; P < .001), vasopressor use (OR, 3.91; 95% CI, 1.59-9.60; P = .003), and longer procedure duration (OR, 1.23/h; 95% CI, 1.01-1.51; P = .04). Multivariable analysis of procedure duration, RBC transfusion, and vasopressor use showed that only RBC transfusion was independently associated with an increased risk of stroke (OR, 10.10; 95% CI, 2.14-47.72; P = .004).
CONCLUSIONS: Blood pressure variability was not associated with an increased risk of postoperative stroke; however, RBC transfusion was an independent risk factor.

BACKGROUND: Blood pressure variability (BPV) is related to clinical outcome in acute ischemic stroke (AIS) treated with reperfusion therapy, but still is not included in clinical practice. This study aims to associate BPV during the first week of AIS with the outcome at three months.
METHODS: We included 236 AIS patients treated with reperfusion therapy, and then divided them into good outcome and poor outcome groups. BPV measurements, including standard deviation, coefficient of variation, average real variability (ARV), and range, were recorded at stages of 2 h, 24 h, and 7 days after reperfusion therapy, respectively. These measurements were compared between the two groups. Then, ROC curve analysis examined the ability of BPV measurements in differentiating good and poor outcome groups; logistic regression analysis detected variables associated with clinical outcome in all subjects.
RESULTS: The good outcome group exhibited significantly less BPV at all stages relative to the poor outcome group. The BPV measurements exhibited the potential to differentiate the two groups by the ROC curve analysis, especially for those at the 24-h stage. Higher ARV of diastolic BP and higher range of systolic BP at the 24-h stage, together with greater disease severity at baseline, were associated with poor clinical outcome.
CONCLUSIONS: Greater BPV during the first week of AIS is associated with poor outcome for the patients treated with reperfusion therapy. The BPV measurements play an important role in modulating clinical outcome, and have the potential to be included in future AIS guidelines.