Arterial hypertension (AHT) is a major risk factor for stroke, yet blood pressure (BP) goals thereafter remain uncertain. Although additional prognostic value of 24-hour ambulant BP monitoring (ABPM) is acknowledged, its clinical impacts remain limited. We suspected that routine ABPM could identify characteristic circadian BP patterns in different brain lesion types, the knowledge of which might, in turn, be helpful in improving overall BP management in patients after stroke. In our study, we compared cardiovascular parameters derived from ABPM and traditional blood pressure measurements (TBPM) among 105 stroke survivors who entered our inpatient neuro-rehabilitation program. The mean age of mostly male (64.8%) patients was 71 ± 12 years. Ischemic strokes were predominant (75.2%). Despite normotensive systolic BP means in TBPM (133.5 ± 18.2 mmHg) and ABPM (24 h: 122.8 ± 14.7 mmHg), AHT persisted in up to 67.6% of all patients, with ABPM uncovering nocturnal systolic non- or reversed dipping in 89.5% and 53.3%, respectively. The latter was predominant (85.7%) in the hemorrhagic subgroup which also displayed lower daytime SBP than the ischemic one (ABPM: 117.1 ± 11.8 vs 124.7 ± 14.7 mmHg, p = 0.033). Further differences were present among distinct brain lesion types. Sufficient dippers were younger (58 ± 12 vs 75 ± 11 years, p < 0.001), but adjusting for age yielded no independent correlations. In spite of normotensive daytime BP measurements, ABPM detects latent AHT and insufficient nocturnal BP dipping after the acute phase of stroke. Further studies are needed to elucidate the role of increased nocturnal BP in patients after stroke.
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We thank Thomas Gaisl, MD (Department of Pulmonology, University Hospital Zurich, Switzerland) for his cross-disciplinary contribution.
Conflict of interest
The authors declare that they have no conflict of interest.
The study was approved by the Cantonal Ethics Committee of Zurich in Switzerland (BASEC-No.: 2016-00247; submission viewable upon request under www.swissethics.ch). The need for patient consent was waived by the board.
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Rejmer, P., Palla, A., Schulz, E.G. et al. Ambulatory blood pressure monitoring on admission in survivors of recent stroke entering inpatient rehabilitation. J Hum Hypertens 34, 364–371 (2020). https://doi.org/10.1038/s41371-019-0237-4