Siesta dipping and circadian blood pressure patterns in acute ischemic stroke

Objective: The purpose of this study was to investigate the alterations of blood pressure (BP) during the midday (siesta time) and the changes of circadian BP patterns in acute phase of ischemic stroke (AIS) with the severity of stroke and their predictive role for the 3 months outcome. Design and method: A total of 228 AIS patients (prospective multicenter follow-up study, NCT01915862) underwent 24-hour ambulatory blood pressure monitoring (ABPM) every 20 minutes within 48 hours from stroke onset using an automated oscillometric device. Clinical and laboratory findings were recorded. Mean BP parameters during day (7:00-22:59), midday (13:00-16:59) and night (23:00-6:59) and siesta and nocturnal dipping were calculated. Endpoints were death and disability/death at 3 months. Results: Siesta SBP dippers had less severe stroke, lower incidence of hypertension and SBP/DBP on admission, lower levels of serum glucose and WBC and delayed initiation of ABPM compared to risers. There was a reverse relation of siesta SBP dipping with both nocturnal dipping (r = -0.27, p<0.001) and the severity of stroke (r = -0.13, p = 0.049). The “double dippers” (siesta and nocturnal dipping) had the least severe stroke, the lowest SBP/DBP on admission and heart rate from ABPM and lower risk of an unfavorable outcome, while the “double risers” had the opposite results, by an approximately 5-fold risk of death/disability at 3 months. Conclusions: These findings indicate different circadian BP patterns according to stroke severity during the acute phase of AIS, potentially driven by patient's physical stress and maybe alterations of the sympathetic nervous system activity, which should be considered as markers of patient's state and prognosis.