Ambulatory blood pressure profile and stroke recurrence

• Published in: Stroke and vascular neurology 2021-09, Vol.6 (3), p.352-358
• Main Authors: Xu, Jie, Jiang, Fei, Wang, Anxin, Zhi, Hui, Gao, Yuan, Tian, Junping, Mo, Jinglin, Chen, Zimo, Xu, An-Ding, Luo, Benyan, Hu, Bo, Zhang, Yuqing, Zhao, Xingquan, Wang, Yilong, Li, Hao, Shen, Haipeng, Wang, Yongjun
• Format: Article
• Language: English
• Subjects: Blood Pressure; Blood Pressure Monitoring, Ambulatory - methods; Brain Ischemia - diagnosis; Cardiovascular disease; Clinical outcomes; Cluster analysis; Females; Humans; Hypertension; Ischemia; Original Research; Prospective Studies; Statistical analysis; Stroke; Stroke - complications; Stroke - diagnosis; Stroke - epidemiology; Transient ischemic attack
• ISSN: 2059-8688; 2059-8696
• DOI: 10.1136/svn-2020-000526

ObjectivesTo establish a new ambulatory blood pressure (ABP) parameter (24-hour ABP profile) and evaluated its performance on stroke outcome in ischaemic stroke (IS) or transient ischaemic attack (TIA) patients.MethodsThe prospective cohort consisted of 1996 IS/TIA patients enrolled for ABP monitoring and a 3-month follow-up for stroke recurrence as outcome. Profile groups of systolic blood pressure (SBP) were identified via an advanced functional clustering method, and the associations of the profile groups and conventional ABP parameters with stroke recurrence were examined in a Cox proportional hazards model.ResultsThree discrete profile groups (n=604, 781 and 611 in profiles 1, 2 and 3, respectively) in 24-hour ambulatory SBP were identified. Profile 1 resembled most to the normal diurnal blood pressure pattern; profile 2 also dropped at night, but climbed earlier and with higher morning surge; while profile 3 had sustained higher nocturnal SBP without significant nocturnal SBP decline. The incidence of stroke recurrence was 2.9%, 3.9% and 5.5% in profiles 1, 2 and 3, respectively. After adjustment for covariates, profile 3 was significantly associated with higher risk of stroke recurrence with profile 1 as reference (HR 1.76, 95% CI: 1.00 to 3.09), while no significant difference was observed between profiles 2 and 1 (HR 1.22, 95% CI: 0.66 to 2.25). None of conventional ABP parameters showed significant associations with the outcome.ConclusionsAmbulatory 24-hour SBP profile is associated with short-term stroke recurrence. Profiles of ABP may help improve identification of stroke recurrence by capturing the additive effects of individual ABP parameters.