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Background Beat‐to‐beat blood pressure variability (BPV) is based on each heartbeat and represents a dynamic equilibrium process modulated by artery and cardiac involvement of pressure‐receptive reflexes. To date, there remains a lack of prospective studies illustrating the clinical value of beat‐to‐beat BPV within 24 hours of acute ischemic stroke onset. Methods and Results This study prospectively monitored beat‐to‐beat blood pressure and heart rate in patients with acute ischemic stroke within 24 hours of onset using a noninvasive plethysmograph and calculated beat‐to‐beat BPV, heart rate variability, and the cross‐correlation baroreflex sensitivity. A modified Rankin Scale score of ≥2 at 90 days was defined as an unfavorable prognosis. Multivariate logistic regression was performed, and the nomogram model was developed by adding the beat‐to‐beat BPV to the traditional model for predicting prognosis. Beat‐to‐beat BPV increased significantly in the unfavorable outcome group (P0.05). Furthermore, beat‐to‐beat BPV within 24 hours of acute ischemic stroke onset was independently associated with unfavorable outcome at 90 days (P

Background Autonomic dysfunction has been revealed in patients with acute ischemic stroke and is associated with poor prognosis. However, autonomic nervous system function assessed by heart rate variability (HRV) and its relationship with clinical outcomes in patients undergoing intravenous thrombolysis (IVT) remain unknown. Methods and Results Patients who did and did not undergo IVT between September 2016 and August 2021 were prospectively and consecutively recruited. HRV values were measured at 1 to 3 and 7 to 10 days after stroke to assess autonomic nervous system function. A modified Rankin scale score ≥2 at 90 days was defined as an unfavorable outcome. Finally, the analysis included 466 patients; 224 underwent IVT (48.1%), and 242 did not (51.9%). Linear regression showed a positive correlation of IVT with parasympathetic activation‐related HRV parameters at 1 to 3 days (high frequency: β=0.213, P=0.002) and with both sympathetic (low frequency: β=0.152, P=0.015) and parasympathetic activation‐related HRV parameters (high frequency: β=0.153, P=0.036) at 7 to 10 days after stroke. Logistic regression showed HRV values and autonomic function within 1 to 3 and 7 to 10 days after stroke were independently associated with 3‐month unfavorable outcomes after adjusting for confounders in patients who underwent IVT (all P