Study of 24 Hour Ambulatory Blood Pressure Monitoring in Acute Stroke Patients

Lee, Seon Mee; Kang, Heung Sun; Song, Jung Sang; Kang, Kyung Eui; Choe, Chung Whee; Kim, Kown Sam; Bae, Jong Hwa

Abstract

OBJECTIVE
Appropriate evaluation of hypertension is important in the patients with a stroke because hypertension is a major cause of a stroke. Blood pressure may be falsely elevated or depressed immediately after a stroke, depending on the severity of neurological deficit, mobility, and physical activity, and the level of consciousness. To overcome this problem, ambulatory blood pressure monitoring (ABPM) has been proposed as a method of obtaining a more accurate clinical assessment.
SUBJECTS AND METHODS
The present study was performed in an acute stage of stroke patients to assess the manifestation of 24 hour ambulatory blood pressure, to observe the nocturnal blood pressure fall and to evaluate the relationship of blood pressure degree on admission and nocturnal blood pressure dip. Thirty four patients admitted within 24 hours after onset of acute stroke were involved in this study. 24 Hour blood pressure monitoring device was installed on an independent arm by oscillometric method as soon as brain imaging study was performed. ABPM readings were obtained each 30 minutes during daytime and each 1 hour during nighttime with electrocardiography. Each patients were classified as the presence or absence of hypertension. We examined nocturnal blood pressure dip and mean pressure of 24 hour ambulatory blood pressure.
RESULTS
1)This study demonstrated that comparing daytime with nighttime 24 hour ambulatory blood pressure, 20 of 24 patients (83%) with acute stroke with hypertension, did not show nocturnal blood pressure dip, and there was sustained high nocturnal blood pressure in patients with acute stroke with hypertension. 2)There were significant differences between 24 hour ambulatory mean daytime blood pressure and mean nighttime blood pressure in patients with acute stroke without hypertension, so was lower in nighttime (p<0.05). 3)It is likely that in acute stroke patients with hypertension, patients with higher blood pressure on admission had more abnormality of nocturnal blood pressure dip.
CONCLUSION
These results suggest that in patients with acute stroke, 24 hour ABPM is useful method to assess diurnal variation and evaluate hypertension in acute stage of stroke patients, and suggest that patients with acute stroke with hypertension trend to loss of nocturnal blood pressure dip.