Ambulatory blood pressure monitoring in stroke survivors: Do we really control our patients?

Castilla-Guerra, Luis; Fernández-Moreno, María del Carmen; Espino-Montoro, Antonio; López-Chozas, José Manuel

doi:10.1016/j.ejim.2009.09.004

Cited by 18 publications

(13 citation statements)

References 28 publications

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“…The circadian rhythm of BP is disrupted during acute stroke and normalizes after a few weeks. [27][28][29] To determine the significance of the rhythm especially on Day 1 seems difficult because an acute consciousness disturbance as well as early initial intensive care for acute stroke might deprive patients of usual day/night life rhythms.…”

Section: Discussionmentioning

confidence: 99%

Effects of 24-Hour Blood Pressure and Heart Rate Recorded With Ambulatory Blood Pressure Monitoring on Recovery From Acute Ischemic Stroke

Tomii

Toyoda

Suzuki

et al. 2011

Stroke

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Background and Purpose-This study used ambulatory blood pressure (BP) monitoring to generate BP and heart rate (HR) profiles soon after stroke onset and evaluated the association between determined values and 3-month stroke outcomes. Methods-We analyzed 24-hour ambulatory BP monitoring records from 104 patients with acute ischemic stroke.Ambulatory BP monitoring was attached at the second and eighth hospitalization days (Days 1 and 7). Both BP and HR were characterized using baseline, mean, maximum, and minimum values and coefficient of variation during 24-hour recording periods. Outcomes at 3 months were assessed as independence according to a modified Rankin Scale score of Յ2 and poor according to the score of Ն5. Results-Sixty-six (63%) patients achieved independence and 12 (11%)

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Section: Discussionmentioning

confidence: 99%

Effects of 24-Hour Blood Pressure and Heart Rate Recorded With Ambulatory Blood Pressure Monitoring on Recovery From Acute Ischemic Stroke

Tomii

Toyoda

Suzuki

et al. 2011

Stroke

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“…Castilla-Guerra et al 16 (Table 2) reported a chronic disruption of circadian rhythm of BP after the acute phase of stroke in a prospective study of 101 patients admitted within 24 hours after stroke onset and followed for one year; although the BP tended to decline and normalize weeks or months after stroke with the effect of medication, this abnormal pattern of circadian rhythm persisted in the majority (approximately threequarters) of stroke patients after a one-year follow-up period. The authors found that the normal diurnal variation in BP was abolished in 87.1% of patients during the acute phase of stroke, in 76.9% after six months, and in 74.6% after one year.…”

Section: Morbidity and Mortality After Stroke Eprosartanmentioning

confidence: 99%

Chronic Management of Hypertension after Stroke: The Role of Ambulatory Blood Pressure Monitoring

Castilla-Guerra

Fernández-Moreno

2015

J Stroke

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The authors have no financial conflicts of interest.Hypertension is the most important potentially reversible risk factor for stroke in all age groups; high blood pressure (BP) is also associated with increased risk of recurrent stroke in patients who have already had an ischemic or hemorrhagic event. Twenty-four hour ambulatory BP monitoring (ABPM) has become an important tool for improving the diagnosis and management of hypertension, and is increasingly used to assess patients with hypertension. Nevertheless, although ABPM devices are increasingly used for assessment of hypertension, their value in the chronic management of hypertension in patients with stroke has not been systematically studied. In fact, among large-scale randomized trials for secondary stroke prevention, only the Morbidity and Mortality After Stroke, Eprosartan Compared With Nitrendipine for Secondary Prevention trial included 24-hour ABPM. ABPM has demonstrated chronic disruption of the circadian rhythm of BP after acute phase of stroke and has shown higher sensitivity compared to office BP in evaluating the effectiveness of antihypertensive treatment among stroke survivors. High 24-hour BP is an independent predictor for cerebrovascular events, brain microbleeds, and subsequent development of dementia. Nevertheless, although stroke care guidelines endorse the importance of hypertension management, the specific role of ABPM among stroke survivors after the acute phase of disease has not been established. Further studies are needed to clarify whether routine application of ABPM among these patients should be recommended.

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“…Castilla-Guera i wsp. postulowali w swojej pracy, że ABPM powinien być stosowany rutynowo u pacjentów ze świeżym udarem, aby precyzyjnie ustalić liczbę i dawki leków hipotensyjnych [26].…”

Section: Nieprawidłowy Rytm Dobowy Ciśnienia Tętniczegounclassified

The prognostic significance of ABPM in patients with acute stroke

Trzmielewska¹,

Jurdziak²

2016

fmpcr

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A -przygotowanie projektu badania, B -zbieranie danych, C -analiza statystyczna, D -interpretacja danych, E -przygotowanie maszynopisu, F -opracowanie piśmiennictwa, G -pozyskanie funduszy Nadciśnienie tętnicze dotyczy około 77% pacjentów z pierwszym udarem mózgu. W przeciwieństwie do uznanych korzyści z obniżania ciśnienia tętniczego w ramach profilaktyki pierwotnej i wtórnej udaru nadal kontrowersyjne pozostaje postępowanie w ostrej fazie udaru. ABPM jest narzędziem diagnostycznym pozwalającym na bardziej wiarygodną w stosunku do pomiarów gabinetowych ocenę wartości BP, uzyskiwanie precyzyjnych informacji co do wartości BP w godzinach nocnych, w czasie codziennej aktywności, a także na ocenę dobowego rytmu ciśnienia tętniczego oraz jego krótko-i długo-okresowej zmienności. Obecnie dysponujemy wynikami kilkudziesięciu badań wskazujących na lepsze znaczenie prognostyczne ABPM w stosunku do pomiarów tradycyjnych w stratyfikacji ryzyka sercowo-naczyniowego, a także przewidywaniu powikłań narządowych nadciśnienia. Zastosowanie ABPM u chorych ze świeżym udarem wymaga dalszych badań. Stwierdzono m.in. że zarówno wysokie, jak i niskie wartości ciśnienia tętniczego w ostrej fazie udaru (oceniane w ABPM, ale nie w pomiarach tradycyjnych), brak nocnego spadku BP, a także wzrost krótko-i długookresowej zmienności powiązane były ze zwiększoną śmiertelnością i gorszym rokowaniem co do powrotu funkcji neurologicznych. Te wnioski wskazują na istotne znaczenie wnikliwej oceny wartości BP we wczesnej fazie udaru oraz na to, że pojedynczy pomiar ciśnienia może się okazać niewystarczający jako czynnik prognostyczny, i tym samym sugerują kliniczną użyteczność ABPM u pacjentów ze świe-żym udarem mózgu. Słowa kluczowe: udar mózgu, nadciśnienie tętnicze, ABPM.Hypertension is present in about 77% of patients with a first episode of stroke. Unlike the established benefit of lowering blood pressure for the primary and secondary prevention of stroke, the management of hypertension in patients with acute stroke remains controversial. ABPM is a diagnostic tool that has been proposed as a method of obtaining a more reliable assessment of patients' blood pressure in comparison with OBPM. ABPM provides precise information about the BP values during the daily activity, during the night period, additionally, about the circadian rhythm of blood pressure and also about the short-and long-term blood pressure variability. There have been several studies that have shown a superior prognostic value of ABPM measurements compared with OBPM in predicting the incidence of CV events. ABPM values were also more closely associated with subclinical organ damage. Simultaneously, more studies are needed to assess the significance of ABPM in patients with acute stroke. Data from many observational studies have suggested that both high and low BP values in the acute phase of stroke (assessed in ABPM, but not in conventional measurements), reduced nocturnal BP fall and increased short-term and long-term BP variability are associated with poorer prognosis in terms...

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Ambulatory blood pressure monitoring in stroke survivors: Do we really control our patients?

Cited by 18 publications

References 28 publications

Effects of 24-Hour Blood Pressure and Heart Rate Recorded With Ambulatory Blood Pressure Monitoring on Recovery From Acute Ischemic Stroke

Effects of 24-Hour Blood Pressure and Heart Rate Recorded With Ambulatory Blood Pressure Monitoring on Recovery From Acute Ischemic Stroke

Chronic Management of Hypertension after Stroke: The Role of Ambulatory Blood Pressure Monitoring

The prognostic significance of ABPM in patients with acute stroke

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