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Blood pressure phenotypes and day-night variability in acute ischemic stroke: is there any cardiovascular mortality
Christina Antza1, Vasilios Kotsis
13rd Department of Internal Medicine, Aristotle University, Hypertension, Hypertension-24 h Ambulatory Blood Pressure Monitoring Center, Papageorgiou Hospital, Thessaloniki, Greece.
Insights
Patients with acute ischemic stroke (AISTR) show a consistent nocturnal circadian rhythm but variable blood pressure (BP) phenotypes. These BP patterns, alongside factors like age and hypertension, predict 10-year cardiovascular death risk.
Area of Science:
- Cardiology
- Neurology
- Hypertension Research
Background:
- Blood pressure (BP) phenotypes and diurnal variations are linked to acute ischemic stroke (AISTR).
- Understanding these patterns in the early stages of AISTR is crucial for predicting long-term outcomes.
Purpose of the Study:
- To analyze BP phenotypes and day-night variability within the first 3 days of AISTR.
- To determine the correlation between these BP characteristics and 10-year cardiovascular death (CVD).
Main Methods:
- Eighty-five AISTR patients underwent 24-hour ambulatory BP monitoring (ABPM) during the initial 3 days of symptoms.
- A phone follow-up was conducted 10 years post-AISTR to assess CVD outcomes.
Main Results:
- A reproducible nocturnal circadian rhythm was observed, with nondipping status being most prevalent.
- BP phenotypes were not consistently reproducible, except for sustained hypertension.
- Cox regression identified age, male sex, diabetes, early vascular aging, TIA, sustained hypertension, and day-night BP ratios as significant predictors of 10-year CVD.
Conclusions:
- AISTR patients exhibit a stable nocturnal circadian rhythm but variable BP phenotypes, with sustained hypertension being an exception.
- Both BP patterns and clinical factors are significant determinants of 10-year cardiovascular death risk.
Objective:
Blood pressure (BP) phenotypes and day-night variability have been associated with acute ischemic stroke (AISTR). The aim of this study was to analyze the BP phenotypes and day-night variability during the first 3 days of an AISTR and their correlation with 10-year cardiovascular death (CVD).
Methods:
Eighty-five volunteers (49.9% men, 77.3 ± 6 years), diagnosed for AISTR, were included in the study. Twenty-four hour ABPM was performed during the first 3 days of AISTR symptoms. A follow-up visit was performed through phone call, 10 years after the AISTR event.
Results:
There is a reproducible nocturnal circadiac rhythm, with the nondipping status to be the most prevalent (89.3%, 89.2%, 88.3% for Days 1, 2, 3 accordingly, P > 0.05), compared to dipping status ( P < 0.05), but not a reproducible BP phenotype, except the hypertensive one (50%, 45.8%, 51.6% for Days 1, 2 and 3 accordingly, P > 0.05). The mean follow-up was 509.6 ± 10 weeks. 37.1% had died (41.2% from MACE). Cox regression analysis revealed that age [odds ratio (OR):1.15, confidence interval (CI): 1.01-1.17, P < 0.05], sex (male, OR: 1.92, CI: 1.07-3.82, P < 0.05), diabetes mellitus (OR: 1.55, CI: 1.06-3.14, P < 0.05), early vascular ageing (OR: 2.01, CI: 1.19-3.74, P < 0.05), transient ischemic attack (OR: 2.32, CI: 1.02-5.34, P < 0.05), sustained hypertension (OR: 2.78, CI: 1.13-6.83, P < 0.05), day-night SBP ratio (OR: 0.98, CI: 0.96-0.99, P < 0.05) and day-night DBP ratio (OR: 0.96, CI: 0.94-0.99, P < 0.05) were significant predictors for CVD.
Conclusion:
Hence, patients with AISTR present a reproducible nocturnal circadian rhythm, but not a reproducible BP phenotype, except sustained hypertension. These parameters found also to be determinants for 10-year CVD.
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