Ambulatory blood pressure monitoring in stroke survivors: Do we really control our patients?

BackgroundWe aim to evaluate prospectively the long-term changes of blood pressure (BP) in stroke survivors using ambulatory BP monitoring (ABPM) and compare them with the clinic conventional measurements.MethodsWe studied 101 patients who were admitted within 24 h after stroke onset. To study the circadian rhythm of BP a continuous BP monitor (Spacelab 90207) was used. After six and twelve months follow-up a new ABPM was undertaken. Data were analyzed using the SSPS 12.0.ResultsWe studied 62 males and 39 females, mean age: 70.9 ± 10.7 years. We included 88 ischemic strokes and 13 hemorrhagic strokes. In the acute phase mean 24 h BPs were 136 ± 19/78.6 ± 11.4 mm Hg. The normal diurnal variation in BP was abolished in 88 (87.1%) patients. After six months, 74 patients were assessed. Mean office readings were 137.5 ± 23.8/76.4 ± 11.4 mm Hg, and high systolic BPs and diastolic BPs were found in 37% and 11% of the subjects respectively. ABPM revealed a mean BP of 118.5 ± 20.1/70.3 ± 8.6 (p < 0.0001). In 57 (76.9%), the normal BP pattern remained abolished (p < 0.001). After one year, 63 patients were assessed. Mean office readings were 130.8 ± 26.3/77.6 ± 9.3 mm Hg, and high systolic BPs and diastolic BPs were found in 23.8% and 10% of the subjects respectively. Mean 24 h BPs were 117 ± 12.5/69.7 ± 7.2 (p < 0.001). The normal diurnal variation in BP was now abolished in 47 (74.6%) patients (p < 0.001).ConclusionSurvivors of stroke, both hypertensive and non-hypertensive patients, present a chronic disruption of circadian rhythm of BP. Conventional clinical recordings are an unreliable method of controlling these patients and ABPM should be routinely performed in this population.