Twenty-four-hour blood pressure profiles following stroke

OBJECTIVES: To investigate 24 h blood pressure profiles after stroke and determine their relationship to outcome. DESIGN: This was a prospective observational study. SUBJECTS: Fifty-five conscious subjects (median age 77 years) admitted to hospital within 24 h of hemiparetic stroke were enrolled; 42 completed the study. METHODS: Stroke patients underwent non-invasive 24 h blood pressure monitoring on days 1 and 7 of hospital admission, and were followed up for between 2 and 6 years. RESULTS: Twenty-four-hour systolic and diastolic blood pressure (SBP and DBP) decreased significantly by 7 mmHg [95% confidence interval (CI): 2 to 13 mmHg, P = 0.01] and 3 mmHg (95% CI 0 to 6 mmHg, P = 0.03), respectively, from day 1 to day 7 (148+/-20/84 +/- 13 mmHg to 141 +/- 20/81 +/- 13 mmHg, respectively). Day-night blood pressure differences on days 1 and 7 were 0.4 +/-10.2/2.1 +/- 6.1 mmHg and -0.7 +/- 12.0/2.5 +/- 8.8 mmHg, respectively. Survival analysis revealed a significantly increased chance of dying for patients with an increasing nocturnal-above-daytime blood pressure on day 7 both for SBP (P = 0.02) and for DBP (P = 0.003). The group of patients dying within 2 years (n = 16) or surviving (n = 26) had similar day*ndash;night SBP and DBP differences on day 1 (0.6 +/- 11.4 compared with 0.3 +/- 9.5 mmHg and 0.6 +/- 6.9 compared with 3.1 +/- 5.4 mmHg, respectively). However, by day 7 nocturnal SBP and DBP were significantly higher than day SBP and DBP in those dying within 2 years, but not in those surviving after this time (SBP difference: -7.0 +/- 11.6 compared with 3.2 +/- 10.9, P = 0.018; DBP difference: -2.6 +/- 8.3 compared with 5.7 +/- 7.6 mmHg, P = 0.004, respectively). CONCLUSION: In those stroke patients with a poor outcome, there was a reversal of the usual 24 h blood pressure profile, such patients having a higher night-time than daytime blood pressure.