Ambulatory blood pressure monitoring in essential hypertensive patients with acute ischaemic stroke
DOI:
https://doi.org/10.14739/2310-1210.2016.6.85489Keywords:
Essential Hypertension, Ischaemic Stroke, Ambulatory Blood Pressure Monitoring, Circadian indexAbstract
Blood pressure (BP) has been identified as a risk factor for various health disorders, including stroke onsets. Hypertension is one of the crucial health problem among adult Ukrainian. Due to the importance of elevated BP in stroke causality, BP measurement remains critical. However, it is limited information about value in clinical practice of ambulatory blood pressure monitoring (ABPM) data in hypertensive patients with inadequately controlled BP with acute stroke compared with those individuals who has no vascular onset.
The aim of the study was to determine ABPM parameters in essential hypertensive patients with ischaemic hemisphere stroke.
Materials and methods. A total of 114 study participants were analyzed (mean age 62 (56;72) years, 40 % women). We divided them into two groups according to the level of 24-h systolic BP (SBP) and diastolic BP (DBP), and the results of clinical examination. The first group (n=83) were inadequately controlled essential hypertensive individuals with high systolic or/and diastolic BP level according to the ABMP results, and the second one (n=31) were EH patients with an acute hemispheric ischaemic stroke (IS). Diagnosis of stroke was confirmed with clinical examination and computed tomography scan or magnetic resonance imaging results, and ABPM was conducted in 4.2±2.3 days after the stroke onset.
Results. We had statistician difference (p<0.001) between groups of such parameters, as average SBP (diurnal, daytime, nighttime); diurnal pulse BP; SBP load (p<0.05); the diurnal AASI (p<0.05); circadian rhythm of DBP (p<0.05). No differences were found between the groups in morning surge calculated as speed and amplitude of the BP climbed in morning hours both for SBP (P=0.422 and P=0.395, respectively) and DBP (P=0.860 and P=0.337, respectively).
Conclusion. In the present study, we evaluated the ABPM parameters in inadequately controlled essential hypertensive individuals with and without acute ischaemic hemispheric stroke. There was no statistical difference in ABPM parameters as for diastolic BP (averages, BP load) and for systolic BP (some parameters of BP load, variability). Meanwhile, there was statistician difference in systolic BP profile (averages, BP load, and the circadian index), pulse BP and the diurnal AASI.
References
Kovalenko, V. M., & Kornatskyi, V. M. (Eds) (2016) Problemy zdorovia i medychnoi dopomohy ta model pokrashchennia v suchasnykh umovakh [Health and medical care problems, and up-to-day improvement model]. Kyiv: Hordon. [in Ukrainian].
Kovalenko V. M. (Ed) (2016) Sertsevo-sudynni zakhvoriuvannia. Klasyfikatsiia, standarty diahnostyky ta likuvannia [Cardiovascular diseases: Classification, practical protocols of diagnosis and treatment]. Kyiv: Morion [in Ukrainian].
Lewington, S., Clarke, R., Qizilbash, N., Peto, R., & Collins, R. (2002) Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet, 360, 1903–1913. doi: http://dx.doi.org/10.1016/S0140-6736(02)11911-8.
Hansen, T. W., Staessend, J. A., Torp-Pedersenb, C., Rasmussen, S., Li, Y., Dolan, E., et al. (2006) Ambulatory arterial stiffness index predicts stroke in a general population Journal of Hypertension, 24, 2247–2253. doi: 10.1097/01.hjh.0000249703.57478.78.
Hansen, T. W., Jepesen, J., Rasmussen, S., Ibsen, H., & Torp-Pedersen, C. (2006) Ambulatory blood pressure monitoring and risk of cardiovascular disease: a population based study Am. J. Hypertens, 19, 243–250. doi: 10.1016/j.amjhyper.2005.09.018.
Aznaouridis, K., Vlachopoulos, Ch., Protogerou, A., & Stefanadis C. (2012) Ambulatory systolic–diastolic pressure regression index as a predictor of clinical events: a meta-analysis of longitudinal studies Stroke, 43, 733–739. doi: 10.1161/STROKEAHA.111.636688.
Skalidi, S. J., Manios, E. D., Stamatelopoulos, K. S., Barlas, G., Michas, F., Toumanidis, S.T. (2013) Brain edema formation is associated with the time rate of blood pressure variation in acute stroke patients Blood Press. Monit., 18, 203–207. doi: 10.1097/MBP.0b013e3283631b28.
Van Sloten, T. T., Sedaghat, S., Laurent, S., London, G. M., Pannier, B., Ikram, M. A., et al. (2015) Carotid stiffness is associated with incident stroke: a systematic review and individual participant data meta-analysis. J. Am. Coll. Cardiol., 66, 2116–2125. doi: 10.1016/j.jacc.2015.08.888.
O’Brien, E., Parati, G., Stergiouc, G., Asmar, R., Beilin, L., Bilo, G., et al. (2013) European society of hypertension position paper on ambulatory blood pressure monitoring J. Hypertens, 9, 1731–1768. doi: 10.1097/HJH.0b013e328363e964.
Parati, G., Stergiouc, G., O’Briend, Е., Asmar, R., Beilin, L., Bilo, G., et al. (2014) European society of hypertension practice guidelines for ambulatory blood pressure monitoring. J. Hypertens., 7, 1359–136. doi: 10.1097/HJH.0000000000000221.
Coca, A. (2016) Hypertension and brain damage, Springer.
Lawes, C. M., Vander Hoorn, S., Rodgers, A., et al. (2001) International society of hypertension. Lancet, 371, 1513–1518.
Nakamura, K., Oita, J., & Yamaguchi, T. (1995) Nocturnal blood pressure dip in stroke survivors: a pilot study. Stroke, 26, 1373–1378. doi: 10.1161/01.STR.26.8.1373. •
Boggia, J., Li, Y., Thijs, L., Hansen, T. W., Kikuya, M., Björklund-Bodegård, K., et al. (2007) Prognostic accuracy of day versus night ambulatory blood pressure: a cohort study Lancet, 370, 1219–1229. doi: 10.1016/S0140-6736(07)61538-4.
Mule, G., Nardi, E., Andronico, G., Cottone, S., Raspanti, F., Piazza, G., et al. (2001) Relationships between 24 h blood pressure load and target organ damage in patients with mild-to-moderate essential hypertension. Blood Press. Monit, 6, 115–123.
Schillaci, G., & Pussi, G. (2011) The relationship between systolic and diastolic blood pressure: a clinically meaningful slope? Hypertension Research 34, 1175–1178. doi: 10.1038/hr.2011.161.
Mancia, G., Fagard, R., Narkiewicz, K., et al. (2013) The Task Force for the management of arterial hypertension of the European Hypertension Society (ESH) and of the European Society of Cardiology (ESC) 2013 ESH. J. Hypertens, 31, 1281–1357.
White, W. B. (2016) Blood pressure monitoring in cardiovascular medicine and therapeutics, Humana Press.
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