Prognostic value of 24-h ABPM in acute ischemic stroke for short-, medium-, and long-term outcome: a systematic review and meta-analysis.
BACKGROUND
The association of blood pressure levels during the acute phase of ischemic stroke with outcome remains controversial.


OBJECTIVE
The objective of this systematic review is to assess the predictive value for stroke outcome assessed by the modified Rankin scale score of systolic and diastolic blood pressure, measured by ambulatory blood pressure monitoring methods during the acute phase of ischemic stroke, compared with the values of casually derived blood pressure measurement on admission.


METHODS
We searched for studies with patients admitted within 24 h of stroke onset, and who had ambulatory blood pressure monitoring during the first 24 h of admission. We identified studies that reported blood pressure in those with good outcome and in those with poor outcome at end of follow-up, and performed a meta-analysis of the effect of mean blood pressure on outcome.


RESULTS
High systolic and diastolic blood pressure levels derived with ambulatory blood pressure monitoring were associated with poor short-, medium-, and long-term outcome, but the same was not found for casual blood pressure measurements. An increase in systolic blood pressure of 9·1 mmHg (95% confidence interval: 6·6-11·6, P < 0·001; I(2)  = 9%) and an increase in diastolic blood pressure of 2·3 mmHg (95% confidence interval: 0·8-3·7, P = 0·002; I(2)  = 0%) were associated with poor outcome.


CONCLUSIONS
Higher systolic and diastolic blood pressure levels derived with ambulatory blood pressure monitoring were associated with poor outcome. The same was not found for higher casual blood pressure measurements on admission, and it is possible that ambulatory blood pressure monitoring conveys better prognostic information.
First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece.
Nikolaos
http://orcid.org/0000-0002-5263-1803
N
Kakaletsis
Department of Medicine, Medical School, University of Thessaly, Larissa, Greece.
George
G
Ntaios
Department of Internal Medicine, Medical School, University of Ioannina, University Hospital of Ioannina, Ioannina, Greece.
Haralampos
H
Milionis
Department of Hygiene and Epidemiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Anna-Bettina
AB
Haidich
Department of Medicine, Medical School, University of Thessaly, Larissa, Greece.
Konstantinos
K
Makaritsis
First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece.
Christos
C
Savopoulos
Department of Internal Medicine, Oslo University Hospital, Oslo, Norway.
Eivind
E
Berge
First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece.
Apostolos I
AI
Hatzitolios
D001794:Blood Pressure / Q000502:physiology*; D002545:Brain Ischemia / Q000150:complications; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D006801:Humans; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology*; D013997:Time Factors
acute ischemic stroke; ambulatory blood pressure monitoring; meta-analysis; outcome; prognosis; systematic review