ASSOCIATION OF CIRCADIAN BLOOD PRESSURE AND HEART RATE PATTERNS WITH SEVERITY OF ACUTE ISCHEMIC STROKE: PRELIMINARY RESULTS

N. Kakaletsis1, H. Milionis2, G. Ntaios3, C. Savopoulos1, K. Makaritsis3, K. Tziomalos1,

G.N. Dalekos3, M. Elisaf2, A.I. Hatzitolios1

LARISSA 21 March 2015

1. First Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece2. Department of Medicine, University of Ioannina, Ioannina, Greece3. Department of Medicine, University of Thessaly, Larissa, Greece

1

Introduction - Aim

Our purpose is to study the relationship between BP course in the acute phase of

stroke by ambulatory 24-hour BP monitoring (ABPM) and stroke severity assessed with the National Institutes of

Health Stroke Scale (NIHSS).

The association of blood pressure (BP) levels following acute ischemic stroke (AIS) with outcome still remains

controversial.

•BP is increased in up to 75% to 80% of patients with acute stroke and usually decreases spontaneously over the next few days. 1-3

•Data from a number of studies suggest that high BP in the acute stroke period is associated with a poor short-term outcome, but in other studies the opposite has been reported. 4-7

•Recently, ambulatory 24-hour BP monitoring (ABPM) which allows the more precisely observation of a rapidly evolving phenomenon such as the BP course in the acute stage of stroke, has been used.

21. Wallace et al, JAMA 1981 2. Britton et al, Stroke 1986 3. Toyoda et al, Stroke 2006 4. Lawes et al, Stroke 2004 5. Robinson et al, Cerebrovasc Dis 1997 6. Allen et al, J Neurol Neurosurg Psychiatry 1984 7. Jorgensen et al, Lancet 1994

Methods

• Inclusion Criteria:– Acute ischemic stroke– Admission within 24 after the onset of symptom

• Exclusion Criteria:– Transient ischemic attack– Intracerebral hemorrhage– Subarachnoid hemorrhage– Cerebral sinus venous thrombosis– Stroke mimics– Late admission (>24 hours after stroke onset)

• Known stroke risk factors and clinical findings on admission were recorded.

• ABPM every 20 min within 24 hours of hospital admission

– automated oscillometric device (TM 2430, A&D Company Ltd) – Day-time; 7:00-22:59– Night-time; 23:00-6:59

• Definitions; – Minor AIS: NIHSS ≤4– Moderate/severe AIS: NIHSS>4

Analysis of parameters derived by ABPM was made by BP analysis software; – Doctor Pro 3 (A&D Company Ltd)

Statistical analysis for continuous data (mean ± standard deviation) was made by Student's T-test, while for non-continuous data (numbers and percentages) chi-square test was used.

– IBM SPSS Statistics for Windows, Version 21.0

3The protocol has been approved by Bioethics Committee of Medical School of Aristotle University of Thessaloniki and local University Hospital Scientific Committees

Blood Pressure Variability in Acute Ischemic Stroke Blood Pressure Variability in Acute Ischemic Stroke (PREVISE study) NCT01915862(PREVISE study) NCT01915862

Clinical characteristics and known stroke risk factors on admission

Variables Population (n=22)NIHSS≤4

(n=9)NIHSS>4 (n=13) p

Pre-Stroke mRS>2 18 (81.8%) 7 (77.8%) 11 (84.6%) 1.000NIHSS admission 9.9 (9.1) 2.3 (1.1) 15.2 (8,5) <0.001Age (years) 79.3 (7) 77.8 (5.6) 80.4 (7.9) 0.404Male gender 12 (54.5%) 6 (66.7%) 6 (46.2%) 0.342Cerebrovascular Disease 6 (27.3%) 3 (33.3%) 3 (23.1%) 0.595Hypertension 19 (86.4%) 8 (88.9%) 11 (84.6%) 1.000Dyslipidemia 15 (68.2%) 7 (77.8%) 8 (61.5%) 0.421Diabetes Mellitus 8 (36.4%) 2 (22.2%) 6 (46.2%) 0.251Atrial Fibrillation 8 (36.4%) 1 (11.1%) 7 (53.8%) 0.040Smoking 6 (27.3%) 3 (33.3%) 3 (23.1%) 0.595Coronary artery Disease 5 (22.7%) 1 (11.1%) 4 (30.8%) 0.279Congestive Heart Failure 3 (13.6%) 0 (0%) 3 (23.1%) 0.240Body Mass Index 29.4 (5.1) 29.6 (5) 29.4 (5.3) 0.927

Statistical analysis for continuous data (mean ± standard deviation) was made by Student’s T-test, while for non-continuous data (numbers and percentages) chi-square test was used.

Parameters derived by 24-h ABPM

• Lower values of DBP (dipping pattern) and HR during night in AIS patients derived by ABPM are associated with minor AIS.

• Furthermore, higher HR values during 24h are associated with moderate/severe AIS.

Conclusions