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High Morning and Bedtime Home Blood Pressures Strongly Predict for Post-Stroke Cognitive Impairment
Yasumasa Yamamoto1, Yoshinari Nagakane2, Yasuhiro Tomii1
1Department of Neurology, Kyoto Katsura Hospital, Kyoto, Japan.
Insights
Home blood pressure (HBP) monitoring, especially at bedtime, is crucial for predicting post-stroke cognitive impairment (PSCI) and stroke recurrence. Elevated HBP levels significantly increase the risk of these adverse outcomes.
Area of Science:
- Neurology
- Cardiology
- Public Health
Background:
- Hypertension is a key modifiable risk factor for post-stroke cognitive impairment (PSCI).
- Understanding the predictive value of home blood pressure (HBP) for PSCI and stroke recurrence is essential for patient management.
Purpose of the Study:
- To investigate the predictive capabilities of HBP, measured in the morning and at bedtime, for PSCI and stroke recurrence.
- To compare the predictive value of HBP with clinic blood pressure (BP) measurements.
Main Methods:
- A cohort of 249 patients with noncardioembolic minor ischemic stroke was studied.
- Home blood pressure was measured in the early morning (m-HBP) and before bedtime (b-HBP).
- Patients were categorized into four groups based on HBP levels and followed for 4.1 years to assess outcomes including silent infarcts, PSCI, and stroke recurrence.
Main Results:
- High HBP, particularly elevated bedtime HBP (HB3 and HB4 categories), was significantly associated with an increased risk of developing PSCI.
- Elevated HBP, especially HB4, and multiple lacunar infarcts (mLI) were strongly linked to stroke recurrence.
- Clinic blood pressure measurements did not show significant associations with any adverse outcomes.
Conclusions:
- Home blood pressure, especially bedtime readings, is a strong predictor of post-stroke cognitive impairment and stroke recurrence.
- Monitoring HBP is recommended for the prevention of PSCI and recurrent strokes.
- Multiple lacunar infarcts are also identified as a significant risk factor for adverse outcomes.
Background:
Hypertension may be the most modifiable risk factor for post-stroke cognitive impairment (PSCI). We investigated how home blood pressure (HBP) can predict PSCI as well as stroke recurrence.
Methods:
We studied 249 consecutive patients with noncardioembolic minor ischemic stroke including single lacunar infarct (sLI), multiple lacunae (mLI), and atherothrombotic infarction, which were tracked at our outpatient clinic. HBP was measured in the early morning (m-HBP) and just before going to bed (b-HBP). HBP categories based on systolic blood pressure were created as follows: HB1, both m-HBP and b-HBP less than 135 (mmHg); HB2, m-HBP less than or equal to135 and b-HBP less than 135; HB3, m-HBP less than 135 and b-HBP less than or equal to 135; HB4, both m-HBP and b-HBP less than or equal to 135. After 4.1 years of tracking, the patients were divided into 4 groups: Group 1, good outcome (n = 188); Group 2, the development of silent infarcts (n = 16); Group 3, the development of PSCI (n = 33); and Group 4, stroke recurrence (n = 15).
Results:
HB2 and HB4 (versus HB1) (hazard ratio [HR]: 6.5, P = .0068 and HR: 9.5, P = .0008, respectively) and mLI (versus sLI) (HR: 4.0, P = .021) were independently associated with Group 2. HB3 and HB4 (HR: 4.2, P = .037; HR: 5.4, P < .0001) and mLI (HR: 6.4, P < .0001) were significantly associated with Group 3. HB4 (HR: 8.1, P = .0002) and mLI (HR: 10.2, P = .0003) were significantly associated with Group 4. Clinic blood pressure (BP) was not significantly associated with any adverse groups.
Conclusions:
High HBP and mLI were strongly associated with PSCI as well as stroke recurrence. BP should be monitored based on HBP, especially bedtime HBP, for the prevention of PSCI.
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