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. 2021 Sep;6(3):352-358.
doi: 10.1136/svn-2020-000526. Epub 2021 Jan 19.

Ambulatory blood pressure profile and stroke recurrence

Jie Xu  1   2 , Fei Jiang  3 , Anxin Wang  1   2 , Hui Zhi  4 , Yuan Gao  5 , Junping Tian  6 , Jinglin Mo  1   2 , Zimo Chen  1   2 , An-Ding Xu  7 , Benyan Luo  8 , Bo Hu  9 , Yuqing Zhang  10 , Xingquan Zhao  1   2 , Yilong Wang  1   2 , Hao Li  2 , Haipeng Shen  11 , Yongjun Wang  12   2
Affiliations

Ambulatory blood pressure profile and stroke recurrence

Jie Xu et al. Stroke Vasc Neurol. 2021 Sep.

Abstract

Objectives: To 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.

Methods: The 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.

Results: Three 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.

Conclusions: Ambulatory 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.

Keywords: blood pressure; stroke.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Ambulatory systolic blood pressure (SBP) profiles in the three cluster groups.
Figure 2
Figure 2
Ambulatory systolic blood pressure (SBP) profiles in the three cluster groups of the validation cohort.
See this image and copyright information in PMC

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