title: High Morning and Bedtime Home Blood Pressures Strongly Predict for Post-Stroke Cognitive Impairment.
abstract: BACKGROUND
  Hypertension may be the most modifiable risk factor for post-stroke cognitive impairment (PSCI). We investigated how home blood pressure (HBP) can predict PSCI as well as stroke recurrence.
  
  
  METHODS
  We studied 249 consecutive patients with noncardioembolic minor ischemic stroke including single lacunar infarct (sLI), multiple lacunae (mLI), and atherothrombotic infarction, which were tracked at our outpatient clinic. HBP was measured in the early morning (m-HBP) and just before going to bed (b-HBP). HBP categories based on systolic blood pressure were created as follows: HB1, both m-HBP and b-HBP less than 135 (mmHg); HB2, m-HBP less than or equal to135 and b-HBP less than 135; HB3, m-HBP less than 135 and b-HBP less than or equal to 135; HB4, both m-HBP and b-HBP less than or equal to 135. After 4.1 years of tracking, the patients were divided into 4 groups: Group 1, good outcome (n = 188); Group 2, the development of silent infarcts (n = 16); Group 3, the development of PSCI (n = 33); and Group 4, stroke recurrence (n = 15).
  
  
  RESULTS
  HB2 and HB4 (versus HB1) (hazard ratio [HR]: 6.5, P = .0068 and HR: 9.5, P = .0008, respectively) and mLI (versus sLI) (HR: 4.0, P = .021) were independently associated with Group 2. HB3 and HB4 (HR: 4.2, P = .037; HR: 5.4, P < .0001) and mLI (HR: 6.4, P < .0001) were significantly associated with Group 3. HB4 (HR: 8.1, P = .0002) and mLI (HR: 10.2, P = .0003) were significantly associated with Group 4. Clinic blood pressure (BP) was not significantly associated with any adverse groups.
  
  
  CONCLUSIONS
  High HBP and mLI were strongly associated with PSCI as well as stroke recurrence. BP should be monitored based on HBP, especially bedtime HBP, for the prevention of PSCI.
authors.affiliation: Department of Neurology, Kyoto Katsura Hospital, Kyoto, Japan. Electronic address: yyamamot@fg7.so-net.ne.jp.
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Yamamoto
authors.affiliation: Department of Neurology, Kyoto Second Red Cross Hospital, Kyoto, Japan.
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Nagakane
authors.affiliation: Department of Neurology, Kyoto Katsura Hospital, Kyoto, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Tomii
authors.affiliation: Department of Neurology, Takeda Hospital, Kyoto, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Akiguchi
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination; D020520:Brain Infarction / Q000209:etiology; D002940:Circadian Rhythm / Q000502:physiology*; D003072:Cognition Disorders / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology*; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension; D007091:Image Processing, Computer-Assisted; D007674:Kidney Diseases / Q000209:etiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D009483:Neuropsychological Tests; D016016:Proportional Hazards Models; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000000981:diagnostic imaging
chemical_list: D003404:Creatinine
keywords: Home blood pressure; bedtime blood pressure; multiple lacunae; post-stroke cognitive impairment