The aim of this study was to analyze the association between the mean of available outpatient blood pressure (BP) measurements recorded during the 12 months preceding stroke and functional outcome at 90 days in patients with stroke, adjusting for other established prognostic factors. This was a prospective, observational study including consecutive adult patients admitted with acute stroke between October 2022 and October 2023. Pre-stroke outpatient BP data were obtained from the shared electronic medical record system of Catalonia. All available outpatient systolic blood pressure (SBP) and diastolic blood pressure (DBP) measurements recorded during the 12 months preceding stroke onset were collected. A total of 187 patients were included. Sixty patients (32.1%) had a poor functional outcome at 90 days, defined as a modified Rankin Scale (mRS) ≥ 3 (>3 in those with a previous mRS = 3). In unadjusted models, mean pre-stroke outpatient SBP and DBP and the outpatient SBP measurement closest to stroke were associated with poor functional outcome at 90 days. In the multivariate analyses adjusted for age, baseline National Institutes of Health Stroke Scale score, pre-stroke mRS, mean in-hospital SBP or DBP, type of stroke and history of atrial fibrillation, pre-stroke SBP (OR 2.52, 95% CI 1.59–4.01, per 1 SD increase, p < 0.001), and pre-stroke DBP (OR 2.78, 95% CI 1.60–4.84, p < 0.001) were associated with a poor outcome. In conclusion, higher mean outpatient BP levels during the year preceding stroke were independently associated with poor functional outcome at 90 days.
White coat hypertension (WCH) in youth has traditionally been considered benign, but it may precede sustained hypertension (SH) and cardiovascular remodelling. We evaluated long-term blood pressure (BP) outcomes and hypertension-mediated organ damage in adolescents with WCH. This preliminary exploratory cohort study included 34 adolescents with WCH and 24 normotensive controls followed for median periods of 8.5 and 7.7 years. Clinical, biochemical, echocardiographic, vascular, and ambulatory BP monitoring (ABPM) assessments were performed at baseline and follow-up. At follow-up, 13 participants with WCH (38.2%) progressed to SH, 2 (5.9%) maintained WCH, and 19 (55.9%) became normotensive; no control developed SH. Participants who progressed had higher baseline ambulatory systolic BP (SBP; 124 vs 119 mmHg, p = 0.004) and pulse pressure (PP; 55 vs 49 mmHg, p = 0.01), while office BP was similar. At follow-up, office BP, ambulatory SBP (131 vs 118 mmHg, p = 0.001), PP (60 vs 45 mmHg, p = 0.003), central SBP (126 vs 121 mmHg, p = 0.032), and augmentation pressure (7 vs 4 mmHg, p = 0.009) were higher in the SH group. Most biochemical parameters, carotid intima-media thickness, and pulse wave velocity were similar between groups. More than one-third of adolescents with WCH progressed to SH. Higher baseline ambulatory SBP and PP may identify those at greater risk. These preliminary findings support individualized, risk-stratified surveillance, with closer ABPM follow-up for adolescents with higher-normal ambulatory BP, wider PP, excess adiposity, persistent office BP elevation, or other cardiovascular risk factors.
In a retrospective audit of 89 adults with spontaneous intracerebral haemorrhage (ICH) at a tertiary neuroscience centre, fewer than 60% met the National Institute for Health and Care Excellence (NICE) blood pressure (BP) target in the year before their haemorrhage, despite most carrying a known diagnosis of hypertension. Blood pressure control and antihypertensive prescribing improved after ICH, yet most survivors remained above the European Stroke Organisation (ESO) secondary-prevention target, and the first documented community BP check occurred a median of 62 days after discharge. These findings expose primary- and secondary-prevention gaps spanning the whole care pathway and lend support to a structured, protocolised uptitration pathway after discharge, combining remote BP monitoring with pharmacist- or nurse-led dose escalation.
