2. G.N. Dalekos3, M. Elisaf2, A.I. Hatzitolios1
ASSOCIATION OF CIRCADIAN BLOOD PRESSURE AND HEART RATE PATTERNS WITH SEVERITY OF ACUTE ISCHEMIC STROKE: PRELIMINARY RESULTS
N. Kakaletsis1, H. Milionis2, G. Ntaios3, C. Savopoulos1, K. Makaritsis3, K. Tziomalos1,
G.N. Dalekos3, M. Elisaf2, A.I. Hatzitolios1
First Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
Department of Medicine, University of Ioannina, Ioannina, Greece
Department of Medicine, University of Thessaly, Larissa, Greece
LARISSA 
21 March 2015

3. Introduction - Aim
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.
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).
1. 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

4. Methods Inclusion Criteria: Exclusion Criteria:
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 21.0
Blood Pressure Variability in Acute Ischemic Stroke (PREVISE study) NCT
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)
The protocol has been approved by Bioethics Committee of Medical School of Aristotle University of Thessaloniki and local University Hospital Scientific Committees

5. Clinical characteristics and known stroke risk factors on admission
Variables
Population (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%)
Dyslipidemia
15 (68.2%)
8 (61.5%)
0.421
Diabetes Mellitus
8 (36.4%)
2 (22.2%)
0.251
Atrial Fibrillation
1 (11.1%)
7 (53.8%)
0.040
Smoking
Coronary artery Disease
5 (22.7%)
4 (30.8%)
0.279
Congestive Heart Failure
3 (13.6%)
0 (0%)
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.

6. Parameters derived by 24-h ABPM
Variables
Population (n=22)
NIHSS≤4
(n=9)
NIHSS>4 (n=13) p
Systolic
24h SBP
147.7 (17.7)
143.8 (14)
149.6 (20)
0.460
Mean day SBP
147.4 (16.9)
144,8 (14.7)
149.2 (18.7)
0.557
Mean night SBP
146.5 (22.2)
140 (16.8)
150.9 (24.9)
0.266
p (day/night)
0.715
0.284
0.607 -
Diastolic
24h DBP
77.4 (11)
74.1 (11.7)
79.7 (11.7)
0.251
Mean day DBP
78.1 (11)
75.2 (9.9)
80.2 (11.6)
0.313
Mean night DBP
75.1 (11.8)
70.1 (8.8)
78.6 (12.6)
0.097
0.033
0.009
0.438
Mean
24h MBP
100.3 (12.7)
96.9 (10.5)
102.7 (13.9)
0.303
Mean day MBP
100.9 (12.5)
98 (11.3)
102.8 (13.4)
0.386
Mean night MBP
98.6 (14.6)
93.1 (10.8)
102.5 (16)
0.142
0.159
0.060
0.849
Heart Rate
24h HR
72.7 (13.7)
63.9 (6.8)
79.1 (13.9)
0.003
Mean day HR
73.2 (12.6)
65.4 (6.9)
78.5 (13)
0.006
Mean night HR
72.7 (17.4)
60.2 (7.5)
81.3 (17.1)
0.001
0.771
0.250
SBP: Systolic BP (mmHg), DBP: Diastolic BP (mmHg), MBP: Mean BP = DBP + Pulse Pressure/3 (mmHg), HR: Heart rate (bpm)
Conclusions
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.