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Published on: February 26, 2013
A new risk factor for predicting stroke in patients with atrial fibrillation: morning blood pressure surge
Ayberk Gorcan1, Onur Argan2, Eyup Avci2
1Balikesir Ataturk City Hospital.
Insights
A morning blood pressure surge (MBPS) and specific blood pressure patterns are significant predictors of stroke in atrial fibrillation patients. Reducing MBPS may offer a new therapeutic target for stroke prevention.
Area of Science:
- Cardiology
- Neurology
- Hypertension Research
Background:
- Atrial fibrillation (AF) poses a significant stroke risk, contributing to mortality and morbidity.
- Investigating stroke predictors in AF patients is crucial for effective prevention strategies.
Purpose of the Study:
- To determine the frequency of stroke in AF patients.
- To identify parameters, including 24-h ambulatory blood pressure monitoring (ABPM) metrics, associated with stroke risk in AF.
Main Methods:
- 282 permanent AF patients underwent 24-h ABPM.
- Morning blood pressure surge (MBPS) defined as post-awakening BP minus nocturnal BP.
- Univariate and multivariate Cox regression analyzed stroke-associated parameters.
Main Results:
- Over 19 months, 22 ischemic strokes occurred.
- Lower stroke rates in dipper BP patterns; higher rates in reverse-dipper patterns.
- Hypertension history, BP pattern, and MBPS were significant stroke predictors (P < 0.001). MBPS >32.5 mmHg predicted stroke with 77% sensitivity and 60% specificity.
Conclusions:
- MBPS, BP pattern, and hypertension are independent stroke predictors in AF.
- Reducing MBPS may represent a novel therapeutic target for stroke prevention in AF patients.
Background:
Stroke, the most feared complication in patients with atrial fibrillation (AF), is still an important cause of mortality and morbidity. In our study, we aimed to investigate the frequency of stroke and related parameters in patients with atrial fibrillation, for whom 24-h ambulatory blood pressure monitoring (ABPM) was performed.
Method:
A total of 282 patients with permanent AF were included in this study. 24-h ABPM was performed in all patients. Morning blood pressure surge (MBPS) was defined as the difference between the mean SBP in the first 2 h after awakening and the lowest blood pressure (BP) at night. We evaluated parameters associated with stroke in patients with atrial fibrillation using univariate and multivariate Cox regression analysis.
Result:
Patients were followed for 19 ± 9.3 months and 22 ischemic strokes were detected during the follow-up period. Also, strokes were significantly lower in atrial fibrillation patients with a dipper BP pattern, whereas strokes were significantly higher in atrial fibrillation patients with a reverse-dipper BP pattern. In multivariate analysis, a history of hypertension ( P = 0.020), BP pattern ( P < 0.001) and MBPS ( P < 0.001) were found to be significantly related to stroke. MBPS levels >32.5 mmHg predicted stroke with a sensitivity of 77% and a specificity of 60% (AUC, 0.741; 95% CI, 0.647-0.834; P < 0.001).
Conclusion:
MBPS, BP pattern and presence of hypertension as an independent risk factor in predicting stroke in patients with atrial fibrillation. The reduction of the MBPS may be a new therapeutic target for preventing stroke.
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