From the University Departments of Medicine for the Elderly (S.L.D.,
B.N.M., M.D.F., J.F.P.), the Glenfield Hospital, Leicester, and the Leicester
General Hospital (S.N.E., T.G.R.), Leicester, UK.
Correspondence to Dr S.L. Dawson, University Department of Medicine for the Elderly, The Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK.
Background and Purpose—It is unclear
whether acute stroke is associated with a loss of the normal diurnal
blood pressure (BP) change and whether stroke type influences this.
Some of this confusion results from the use of fixed time definitions
of day and night, which can be overcome by the use of cumulative sums
analysis (cusums).
Methods—Ninety-eight stroke patients had 24-hour BP monitoring
(Spacelabs 90207) performed within 48 hours of ictus. Three subgroups
were identified: cortical infarct, n=50; subcortical infarct, n=29; and
primary intracerebral hemorrhage [PICH],
n=19. An age-matched control group of 74 subjects was also studied.
Diurnal change was assessed by both day-night differences (absolute and
percentage) and cusums (cusums plot height [CPH] and circadian
alteration magnitude [CDCAM]); ANCOVA was used to compare groups.
Results—Compared with control subjects, cortical infarct and PICH
subgroups had significantly reduced mean diurnal systolic
changes using day-night differences (absolute, –12 and –17
mm Hg; percentage, –10 and –12, respectively;
P<0.0001) and cusums (CDCAM, –6.96 and –8.6
mm Hg; CPH, –32.05 and –46.04 mm Hg, respectively;
P<0.005), only the subcortical infarct subgroup
demonstrated reduced percentage differences (–4.4%,
P<0.02). Mean diastolic differences were
significantly reduced in all stroke subgroups(CPH, –24.84, –17.31,
and –36.92 mm Hg; absolute, –8.26, –4.04, and –11.44
mm Hg; percentage, –10.65, –5.81, and –15.23%, for cortical
infarct, subcortical infarct, and PICH subgroups, respectively;
P<0.05), except for CDCAM, which was not reduced in
subcortical infarcts (–4.78 and –7.70 mm Hg for cortical
infarct and PICH subgroups, respectively; P<0.001).
Conclusions—Diurnal BP change was reduced in the 3 stroke
subgroups studied, especially in patients with cortical infarcts and
PICH. This may reflect damage to the central modulation of autonomic BP
control. The implications in terms of prognosis and therapy in the
acute period require further study.
© 1998 American Heart Association, Inc.
Original Contributions
Diurnal Blood Pressure Change Varies With Stroke Subtype in the Acute Phase
Key Words: analysis, cumulative sums • blood pressure • circadian rhythm • stroke, acute
This article has been cited by other articles:
 |
|
 |
|
  H. P. Mattle, L. Kappeler, M. Arnold, U. Fischer, K. Nedeltchev, L. Remonda, S. M. Jakob, and G. Schroth Blood Pressure and Vessel Recanalization in the First Hours After Ischemic Stroke Stroke, February 1, 2005; 36(2): 264 - 268. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. G. Robinson, S. L. Dawson, P. J. Eames, R. B. Panerai, J. F. Potter, and S. Oppenheimer Cardiac Baroreceptor Sensitivity Predicts Long-Term Outcome After Acute Ischemic Stroke * Editorial Comment Stroke, March 1, 2003; 34(3): 705 - 712. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Sinha and E.A. Warburton The evolution of stroke units--towards a more intensive approach? QJM, September 1, 2000; 93(9): 633 - 638. [Full Text] [PDF]
|
|
|
|
|
|
S. L. Dawson, B. N. Manktelow, T. G. Robinson, R. B. Panerai, and J. F. Potter Which Parameters of Beat-to-Beat Blood Pressure and Variability Best Predict Early Outcome After Acute Ischemic Stroke? Stroke, February 1, 2000; 31(2): 463 - 468. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Y. H. Lip, C. R. Gibbs, and D. G. Beevers Ambulatory Blood Pressure Monitoring and Stroke : More Questions Than Answers Stroke, August 1, 1998; 29(8): 1495 - 1497. [Full Text] [PDF]
|
|