RT Journal Article
SR Electronic
T1 Ambulatory blood pressure profile and stroke recurrence
JF Stroke and Vascular Neurology
JO Stroke Vasc Neurol
FD BMJ Publishing Group Ltd
SP svn-2020-000526
DO 10.1136/svn-2020-000526
A1 Jie Xu
A1 Fei Jiang
A1 Anxin Wang
A1 Hui Zhi
A1 Yuan Gao
A1 Junping Tian
A1 Jinglin Mo
A1 Zimo Chen
A1 An-Ding Xu
A1 Benyan Luo
A1 Bo Hu
A1 Yuqing Zhang
A1 Xingquan Zhao
A1 Yilong Wang
A1 Hao Li
A1 Haipeng Shen
A1 Yongjun Wang
YR 2021
UL http://svn.bmj.com/content/early/2021/01/18/svn-2020-000526.abstract
AB 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.