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.