Hypertension and daytime hypotension found on ambulatory blood pressure is associated with fatigue following stroke and TIA

Background: Fatigue affects up to 68 of subjects following stroke. In non-stroke patients, associations are reported between chronic fatigue and both hypertension and hypotension. We hypothesized that, in patients with stroke or transient ischaemic attack (TIA), an association may exist between fatigue and abnormal blood pressure (BP) detected on ambulatory monitoring. Methods: Subjects recruited from a secondary prevention clinic underwent 24-h ambulatory BP monitoring and completed a questionnaire including the Fatigue Severity Scale (FSS). Results: One hundred subjects were included (51 female, mean age 69 years). Mean FSS was 3.6 and 42 has a FSS 4 indicative of significant fatigue. Mean daytime BP for all subjects was 134/74 (SD 16/11 mmHg). There was no significant difference in mean BP between patients with and those without significant fatigue. Patients with stroke suffered worse fatigue than those with TIA (mean FSS 3.8 vs. 3.0, P 0.03). Twenty-four subjects were hypertensive (mean 24-h BP 145/90 mmHg), 26 had a lowest daytime diastolic BP (DBP) 50 mmHg and 4 had both. Fifty-four subjects were normotensive and these had a significantly lower mean FSS than either those with hypertension (mean FSS 3.2 vs. 4.2, P 0.02, t-test) or those with low DBP (mean FSS 3.2 vs. 4.2, P 0.01, t-test). Hypertensive subjects were more likely to be significantly fatigued [(2) 3.8, P 0.05, OR 3.1 (1.18.3)] as were subjects with low daytime DBP [(2) 8.4, P 0.004, OR 4.2 (1.511.1)]. Conclusion: In subjects who have suffered a stroke or TIA, fatigue is associated with measures of both hypertension and hypotension on ambulatory monitoring. Patients with stroke suffered worse fatigue than those with TIA.