Blood pressure phenotypes and day-night variability in acute ischemic stroke: is there any cardiovascular mortality link 10 years after?

Abstract

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.