Diurnal blood pressure variations in patients with hypertension and stroke or transient ischemic attack

Abstract

Background It was found that non-dipper and extreme dipper blood pressure profile, increased blood pressure variability and morning surge of blood pressure are risk factors of stroke in hypertensive patients. Less is known about changes in blood pressure pattern in acute phase of cerebrovascular event. The aim of the study was to compare changes in blood pressure pattern in patients with ischemic stroke and those with TIA.
Material and methods Twenty five hypertensive patients with symptoms of stroke (15 patients with acute ischemic stroke and 10 patients with TIA) and 15 patients with newly diagnosed uncomplicated hypertension were studied. 24-h ABPM was performed on the third day of hospitalization in patients with cerebrovascular event and on the first day, before antihypertensive therapy in hypertensive controls.
Results Mean 24-hour systolic blood pressure was significantly higher (p < 0,001) in patients with stroke (152,3 ± 17,3 mm Hg) than in patients with TIA (129,3 ± 14,1 mm Hg) while maximal fall in systolic blood pressure was significantly higher in patients with TIA (87,3 ± 16,8 mm Hg) in comparison with patients with stroke and patients with uncomplicated hypertension (110,8 ± 25,7 and 103,4 ± 15,2 mm Hg respectively). Night blood pressure fall was decreased in stroke patients (5,4 ± 2,3%) and 24-h blood pressure variability was increased in patients with TIA.
Conclusions Systolic blood pressure normalizes faster in patients with TIA than in patients with acute ischemic stroke. Greater maximal drops in systolic blood pressure were also noticed in patients with TIA. Night systolic blood pressure fall was diminished in patients with acute stroke while 24-h blood pressure variability was increased in patients with TIA.