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Abnormal blood pressure circadian rhythm in acute ischaemic stroke: Are lacunar strokes really different?
International Journal of Stroke, 08/17/09

Castilla–Guerra L et al. – Results show clear differences in blood pressure (BP) circadian rhythm of acute ischaemic stroke between lacunar and nonlacunar infarctions by 24-hr BP monitoring. Nocturnal systolic and diastolic BP dip was significantly higher in lacunar strokes. Lacunar stroke pts had a higher percentage of dipping patterns in diastolic BP circadian rhythm.

Methods

Study of changes in circadian BP patterns in pts with acute ischemic stroke and relation to stroke subtype
Assessment of 98 consecutive pts admitted within 24 hr after ischemic stroke onset
Clinical examination, laboratory studies and CT scan study of brain on admission
Continuous BP monitoring for BP circadian rhythm
Pt classification by percentage fall in mean systolic BP or diastolic BP at night vs day:
Dippers: fall ≥10–20%
Extreme dippers: ≥20%
Nondipper: <10%
Reverse dippers: <0% as increase in mean nocturnal BP vs mean daytime BP)
Data analysis in 2 groups: lacunar and nonlacunar infarctions

Results

Pt population: 60 males; 38 females, mean age: 70.5±11 yrs; 62 (63.2%) lacunar strokes; 36 (36.8%) nonlacunar strokes
Most common risk factor: hypertension: 67 pts, 68.3%
Other risk factors: hypercholesterolemia (44 pts, 44.8%), diabetes mellitus (38 pts, 38.7%), smoking (24 pts, 24.8%), atrial fibrillation (19 pts, 19.3%)
Lacunar strokes pts: predominantly men; lower frequency of atrial fibrillation
Mean BP in acute phase: 136±20 mmHg systolic BP; 78.7±11.8 mmHg diastolic BP
No differences in 24-hr systolic BP and 24-hr diastolic BP between pts with lacunar and nonlacunar infarction
Lacunar infarction pts showed mean decline in day–night systolic and diastolic BP of ~4 mmHg vs nonlacunar strokes
Nonlacunar stroke pts: lack of 24-hr nocturnal systolic and diastolic BP fall
Normal diurnal variation in systolic BP abolished in 87 (88.9%) pts
Variation in diastolic BP in 76 (77.5%) pts
For lacunar vs nonlacunar strokes, normal diurnal variation in systolic BP abolished in 53 (85.4%) lacunar strokes and in 34 (94.4%) nonlacunar strokes
For diurnal variation in diastolic BP, normal diurnal variation in systolic BP abolished in 43 (69.3%) lacunar strokes and in 33 (91.6%) nonlacunar strokes