title: Association of ambulatory blood pressure and heart rate with advanced white matter lesions in ischemic stroke patients.
abstract: BACKGROUND
  White matter lesions (WMLs) are a common finding in stroke patients, and the most important risk factors are old age and hypertension. Although many studies have described the association between WMLs and ambulatory blood pressure monitoring (ABPM) parameters in healthy subjects and hypertensive patients, little is known about the association in hypertensive ischemic stroke patients.
  
  
  METHODS
  From July 2009 to June 2012, 169 consecutive hypertensive noncardioembolic ischemic stroke patients were recruited within 1 week of suffering a stroke, and ABPM was applied 1 or 2 weeks after stroke onset. The subjects were classified into 2 groups according to the presence of advanced WMLs, and their ABPM parameters were compared. Finally, multivariable logistic regression analyses were performed to investigate the independent relationships between WMLs and ABPM parameters.
  
  
  RESULTS
  Seventy (41%) patients had advanced WMLs. In univariable analysis, higher 24-hour, awake, and asleep systolic blood pressure (SBP)/diastolic blood pressure levels and 24-hour pulse pressure were associated with advanced WMLs. However, circadian blood pressure parameters such as 24-hour BP variability, morning surge, and nocturnal dipping pattern were not associated with advanced WMLs. After adjustments, old age (odds ratio (OR) = 1.063; 95% confidence interval (CI) = 1.024-1.104; P = 0.002), high 24-hour SBP levels (OR = 1.055; 95% CI = 1.028-1.082; P < 0.001), and high 24-hour heart rate (OR = 1.041; 95% CI = 1.006-1.078; P = 0.023) were independently associated with advanced WMLs.
  
  
  CONCLUSIONS
  In addition to old age and elevated 24-hour SBP, increased heart rate is associated with advanced WMLs in ischemic stroke patients. Heart rate deserves more attention in predicting advanced WMLs in those patients.
authors.affiliation: Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea.
authors.forename: Hyuk Sung
authors.initials: HS
authors.lastname: Kwon
authors.forename: Young-Hyo
authors.initials: YH
authors.lastname: Lim
authors.forename: Hyun Young
authors.initials: HY
authors.lastname: Kim
authors.forename: Hee-Tae
authors.initials: HT
authors.lastname: Kim
authors.forename: Hyung-Min
authors.initials: HM
authors.lastname: Kwon
authors.forename: Jae-Sung
authors.initials: JS
authors.lastname: Lim
authors.forename: Young-Jun
authors.initials: YJ
authors.lastname: Lee
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Kim
authors.forename: Young Seo
authors.initials: YS
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm; D005260:Female; D006339:Heart Rate; D006801:Humans; D056784:Leukoencephalopathies / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000150:complications*
keywords: ambulatory blood pressure monitoring; blood pressure; heart rate; hypertension; ischemic stroke; white matter lesions.