Objective: Declining nocturnal blood pressure (BP) has been shown to independently predict the incidence of cardiovascular events, including ischemic stroke. We studied whether nocturnal BP dipping is related to tissue outcome after ischemic stroke (AIS). Design and method: In a prospective study, we enrolled 75 consecutive AIS patients (51 males, age 63.0 ± 12.5 years, admission National Institutes of Health Stroke Scale score of 6.1 ± 5.0, SD ± mean) admitted within 24 hours after onset. BP dipping (SpaceLabs) (nighttime BP – daytime BPx100/daytime BP) was measured one week after stroke onset. Serial brain magnetic resonance imaging (MRI) were analyzed. Cerebral lesion was measured semiautomatically using the diffusion weigted MRI (DWI) at admission (baseline) and at day 5 ± 1 (final) after stroke onset. Infarct growth was defined as (final – baseline/baseline) core volume. High cerebral lesion growth was determined as the highest quintile in DWI lesion volume increase and compared with the lowest quintile used as the reference group. Data were analyzed with multivariate logistic regression. Results: In univariate analysis, nocturnal systolic BP (SBP) decline was significantly associated with cerebral lesion growth (p=0.04). Nocturnal SBP decline was lower in patients with high cerebral lesion growth than in patients of the reference group (98.0 ± 5.1 vs. 91.7 ± 7.0; p=0.01). Thrombolytic treatment also predicted post-stroke tissue outcome (p=0.046). In multivariate analysis, the predictive value of nocturnal SBP decline remained significant (OR = 1.26; 95% CI, 1.02-1.56; p=0.036) after adjustment on age, sex, and use of thrombolysis. Conclusions: This study indicates that nocturnal SBP dipping is an independent determinant of tissue outcome in acute ischemic stroke.
Gąsecki et al. (Fri,) studied this question.