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ASSOCIATION OF CIRCADIAN BLOOD PRESSURE AND HEART RATE PATTERNS WITH SEVERITY OF ACUTE ISCHEMIC STROKE: PRELIMINARY RESULTS N. Kakaletsis 1, H. Milionis.

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Presentation on theme: "ASSOCIATION OF CIRCADIAN BLOOD PRESSURE AND HEART RATE PATTERNS WITH SEVERITY OF ACUTE ISCHEMIC STROKE: PRELIMINARY RESULTS N. Kakaletsis 1, H. Milionis."— Presentation transcript:

1 ASSOCIATION OF CIRCADIAN BLOOD PRESSURE AND HEART RATE PATTERNS WITH SEVERITY OF ACUTE ISCHEMIC STROKE: PRELIMINARY RESULTS N. Kakaletsis 1, H. Milionis 2, G. Ntaios 3, C. Savopoulos 1, K. Makaritsis 3, K. Tziomalos 1, G.N. Dalekos 3, M. Elisaf 2, A.I. Hatzitolios 1 LARISSA 21 March First Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece 2.Department of Medicine, University of Ioannina, Ioannina, Greece 3.Department of Medicine, University of Thessaly, Larissa, Greece 2

2 Introduction - Aim Our purpose is to study the relationship between BP course in the acute phase of stroke by ambulatory 24-hour BP monitoring (ABPM) and stroke severity assessed with the National Institutes of Health Stroke Scale (NIHSS). The association of blood pressure (BP) levels following acute ischemic stroke (AIS) with outcome still remains controversial. BP is increased in up to 75% to 80% of patients with acute stroke and usually decreases spontaneously over the next few days. 1-3 Data from a number of studies suggest that high BP in the acute stroke period is associated with a poor short- term outcome, but in other studies the opposite has been reported. 4-7 Recently, ambulatory 24-hour BP monitoring (ABPM) which allows the more precisely observation of a rapidly evolving phenomenon such as the BP course in the acute stage of stroke, has been used Wallace et al, JAMA Britton et al, Stroke Toyoda et al, Stroke Lawes et al, Stroke Robinson et al, Cerebrovasc Dis Allen et al, J Neurol Neurosurg Psychiatry Jorgensen et al, Lancet 1994

3 Methods Inclusion Criteria: – Acute ischemic stroke – Admission within 24 after the onset of symptom Exclusion Criteria: – Transient ischemic attack – Intracerebral hemorrhage – Subarachnoid hemorrhage – Cerebral sinus venous thrombosis – Stroke mimics – Late admission (>24 hours after stroke onset) Known stroke risk factors and clinical findings on admission were recorded. ABPM every 20 min within 24 hours of hospital admission – automated oscillometric device (TM 2430, A&D Company Ltd) – Day-time; 7:00-22:59 – Night-time; 23:00-6:59 Definitions; – Minor AIS: NIHSS ≤4 – Moderate/severe AIS: NIHSS>4 Analysis of parameters derived by ABPM was made by BP analysis software; – Doctor Pro 3 (A&D Company Ltd) Statistical analysis for continuous data (mean ± standard deviation) was made by Student's T-test, while for non-continuous data (numbers and percentages) chi- square test was used. – IBM SPSS Statistics for Windows, Version The protocol has been approved by Bioethics Committee of Medical School of Aristotle University of Thessaloniki and local University Hospital Scientific Committees Blood Pressure Variability in Acute Ischemic Stroke (PREVISE study) NCT

4 Clinical characteristics and known stroke risk factors on admission VariablesPopulation (n=22) NIHSS≤4 (n=9) NIHSS>4 (n=13)p Pre-Stroke mRS>2 18 (81.8%)7 (77.8%)11 (84.6%)1.000 NIHSS admission 9.9 (9.1)2.3 (1.1)15.2 (8,5)<0.001 Age (years) 79.3 (7)77.8 (5.6)80.4 (7.9)0.404 Male gender 12 (54.5%)6 (66.7%)6 (46.2%)0.342 Cerebrovascular Disease 6 (27.3%)3 (33.3%)3 (23.1%)0.595 Hypertension 19 (86.4%)8 (88.9%)11 (84.6%)1.000 Dyslipidemia 15 (68.2%)7 (77.8%)8 (61.5%)0.421 Diabetes Mellitus 8 (36.4%)2 (22.2%)6 (46.2%)0.251 Atrial Fibrillation 8 (36.4%)1 (11.1%)7 (53.8%)0.040 Smoking 6 (27.3%)3 (33.3%)3 (23.1%)0.595 Coronary artery Disease 5 (22.7%)1 (11.1%)4 (30.8%)0.279 Congestive Heart Failure 3 (13.6%)0 (0%)3 (23.1%)0.240 Body Mass Index 29.4 (5.1)29.6 (5)29.4 (5.3)0.927 Statistical analysis for continuous data (mean ± standard deviation) was made by Student’s T-test, while for non-continuous data (numbers and percentages) chi-square test was used.

5 Parameters derived by 24-h ABPM Variables Population (n=22) NIHSS≤4 (n=9) NIHSS>4 (n=13) p Systolic 24h SBP147.7 (17.7)143.8 (14)149.6 (20) Mean day SBP147.4 (16.9)144,8 (14.7)149.2 (18.7) Mean night SBP146.5 (22.2)140 (16.8)150.9 (24.9) p (day/night) Diastolic 24h DBP77.4 (11)74.1 (11.7)79.7 (11.7) Mean day DBP78.1 (11)75.2 (9.9)80.2 (11.6) Mean night DBP75.1 (11.8)70.1 (8.8)78.6 (12.6) p (day/night) Mean 24h MBP100.3 (12.7)96.9 (10.5)102.7 (13.9) Mean day MBP100.9 (12.5)98 (11.3)102.8 (13.4) Mean night MBP98.6 (14.6)93.1 (10.8)102.5 (16) p (day/night) Heart Rate 24h HR72.7 (13.7)63.9 (6.8)79.1 (13.9) Mean day HR73.2 (12.6)65.4 (6.9)78.5 (13) Mean night HR72.7 (17.4)60.2 (7.5)81.3 (17.1) p (day/night) SBP: Systolic BP (mmHg), DBP: Diastolic BP (mmHg), MBP: Mean BP = DBP + Pulse Pressure/3 (mmHg), HR: Heart rate (bpm) Lower values of DBP (dipping pattern) and HR during night in AIS patients derived by ABPM are associated with minor AIS. Furthermore, higher HR values during 24h are associated with moderate/severe AIS. Conclusions


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