Abstract 10097: Clinical Use of Ambulatory Blood Pressure Monitoring in the Prediction of Prognosis in Stroke Patients
Background: Arterial blood pressure (BP) has a daily variation. Hypertensive patients with an excessive morning surge in BP and/or lack of nocturnal BP fall have been shown to have increased incidence of cardiovascular events. However, we have little information about the circadian rhythm of BP on the recurrence and mortality in the stroke patients. We studied to assess clinical utility of ambulatory blood pressure monitoring (ABPM) and determine the prognostic factors in stroke patients.
Materials and method: Total 468 stroke patients underwent their first ABPM were screened from August 2001 to July 2005. After exclusion of 42 patients with end-stage renal disease, severe organ failure and peripheral arterial diseases, 426 patients were analyzed. According to BP dropping pattern during night-time compared with day-time, the patients were classified into extreme-dipper (>20%), dipper (10~20%), non-dipper (<10%) and reverse-dipper (BP rises during night-time). The patients were followed for further 7.6±3.1 years for checking of recurrence or all-cause mortality.
Results: Of 426 patients, 202 patients were non-dipper (47%), 134 were reverse-dipper (32%), 80 were dipper (19%) and 10 were extreme-dipper (2%). During the follow-up period, 89 patients (21%) had recurrence of stroke. After multivariate analysis, day-time mean systolic BP (HR=1.014, P=0.018) was significant predictor of recurrence. There were 141 deaths (33%) in our study cohort. Nocturnal mean heart rate (HR=1.022, P=0.006) and reverse-dipping (HR=1.616, P=0.013) were significantly associated with total mortality.
Conclusion: These finding suggest that night-time mean systolic BP was associated with recurrence of stroke, and reverse-dipping and night-time mean heart rate appeared to be strong predictors of total mortality in stroke patients.
- © 2013 by American Heart Association, Inc.