title: Ambulatory blood pressure monitoring in acute stroke: pathophysiology of the time rate of blood pressure variation and association with the 1-year outcome.
abstract: OBJECTIVE
  Time rate of blood pressure (BP) variation is a measure of the speed of BP fluctuations derived from a computerized analysis of ambulatory BP monitoring. The aim of this study was to identify pathophysiological differences in the time rate of BP variation between stroke subtypes, on the basis of the Trial of Org 10172 in Acute Stroke Treatment criteria, in the acute phase and to examine the impact of time rate of BP variation on outcome at 1 year after stroke.
  
  
  METHODS
  A consecutive series of 109 first-ever stroke patients, who fulfilled our inclusion criteria, underwent 24 h ambulatory BP monitoring within 24 h after the onset of stroke. On the basis of the patients' Modified Rankin Scale score at 1 year after stroke, the study population was divided into two groups: patients with a positive (n=73) and those with a negative outcome (n=36).
  
  
  RESULTS
  The 24-h rate of systolic BP variation is higher in patients with large artery atherosclerosis [0.692 mmHg/min; 95% confidence interval (CI) 0.627-0.757] compared with those with lacunar strokes (0.609 mmHg/min; 95% CI 0.579-0.640) or strokes of unknown etiology (0.586 mmHg/min; 95% CI 0.522-0.649). Moreover, patients with higher 24-h rates of systolic BP variation were more likely to have a negative outcome at 1 year (odds ratio 1.96; 95% CI 1.16-3.32). Moreover, each 0.1 mmHg/min increase in the 24-h rate of SBP variation was associated with a 1.96-fold increase in the odds of a negative outcome (95% CI 1.16-3.32).
  
  
  CONCLUSIONS
  Time rate of BP variation shows significant differences between stroke subtypes in the acute phase of the event, and it is associated with outcome at 1 year. Lowering the time rate of BP variation, in the acute phase, might lead to better outcomes in patients who have had a cerebrovascular incident.
authors: Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece. takiszis@gmail.com
authors: Panagiotis
authors: P
authors: Zis
authors: Konstantinos
authors: K
authors: Vemmos
authors: Konstantinos
authors: K
authors: Spengos
authors: Efstathios
authors: E
authors: Manios
authors: Vassilios
authors: V
authors: Zis
authors: Meletios-Athanasios
authors: MA
authors: Dimopoulos
authors: Nikolaos
authors: N
authors: Zakopoulos
mesh_terms: D000208:Acute Disease; D000368:Aged; D018660:Blood Pressure Monitoring, Ambulatory; D002545:Brain Ischemia / Q000503:physiopathology; D002543:Cerebral Hemorrhage / Q000503:physiopathology; D002940:Circadian Rhythm; D003971:Diastole; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000503:physiopathology*; D013599:Systole; D013997:Time Factors; D016896:Treatment Outcome