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

Background: We 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. Methods: We 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. Results: We 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). Conclusion: Survivors 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. (C) 2009 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.