Artery Research

Volume 25, Issue Supplement 1, December 2019, Pages S155 - S155

P115 Does Post-stroke White Coat Hypertension/Effect (WCH/E) Require Intensive Blood Pressure Management?

Authors
Fran Kirkham1, *, GN Nuredini2, A Saunders2, Erin Drazich1, Eva Bunting1, Philip Rankin1, K Ali1, 2, M Okorie1, 2, Chakravarthi Rajkumar1, 2
1Department of Elderly Care and Stroke Medicine, Brighton and Sussex University Hospitals Trust, Brighton, UK
2Department of Medicine, Brighton and Sussex Medical School, Brighton, UK
*Corresponding author. Email: cooldudettefran@hotmail.com
Corresponding Author
Fran Kirkham
Available Online 17 February 2020.
DOI
10.2991/artres.k.191224.141How to use a DOI?
Abstract

Objective: International guidelines advocate conservative management of post-stroke white coat hypertension. The aims of this study were to investigate; i) does WCH/E result in increased stroke risk? and ii) is WCH/E associated with surrogate markers of cardiovascular risk?

Methods: The Arterial Stiffness In Lacunar Stroke and TIA (ASIST) study recruited 96 patients, aged over 40 years old, with a confirmed diagnosis of transient ischaemic attack (TIA) or lacunar stroke in the preceding 14 days. Patients were grouped by BP phenotypes. Thirty-four patients were excluded (n = 6 declined ABPM, n = 3 masked hypertension, n = 25 sustained hypertension). Thirty-two patients with normal BP (clinic BP <140/90 mmHg and day-time ABPM <135/85 mmHg), and 30 patients with WCH/E (clinic BP >140/90 mmHg and day-time ABPM <135/85 mmHg) were recruited. Other surrogate markers measured were; Central aortic BP (SphygoCor, AtCor Medical), QKD100-60 interval and nocturnal dipping status (Diasys Integra II, Novocor).

Results: Compared to the normotensive cohort, patients with WCH/E were older, had a higher body mass index (BMI) and a larger proportion of patients were on anti-hypertensive medication. Both central systolic (145 ± 13 vs 118 ± 8, p < 0.001) and diastolic BP (82 ± 8 vs 76 ± 7, p = 0.004) were higher in WCH/E. The WCH/E cohort also had more lacunar strokes (p = 0.039) (Table 1).

Conclusion: In this population of post-stroke patients, WCH/E was associated with higher prevalence of lacunar stroke. These individuals also had higher central pressures despite more patients being on anti-hypertensive treatment, suggesting that post-stroke WCH/E should be managed more aggressively.

Normotension (N = 32) WCH/E (N = 30) Significance
Male, n (%) 21 (66) 22 (73) 0.511
Age (years) 69.9 ± 11.5 75.7 ± 9 3 0.033
BMI (kg/m2) 25 ± 4 28 ± 4 0.014
Anti-hypertensive use, n (%) 19 (59) 23 (77) 0.146
Clinic SBP (mmHg) 125 ± 9 155 ± 13 <0.001
Clinic DBP (mmHg) 75 ± 7 81 ± 8 0.003
Daytime systolic ABPM (mmHg) 114 ± 10 121 ± 10 0.007
Daytime diastolic ABPM (mmHg) 73 ± 7 72 ± 7 0.586
Central SBP (mmHg) 118 ± 8 145 ± 13 <0.001
Central DBP (mmHg) 76 ± 7 82 ± 8 0.004
QKD100−60 interval (msec) 208 ± 18 197 ± 26 0.114
Non-dipper, n (%) 16 (57) 14 (50) 0.592
Stroke type
 TIA, n (%) 25 (78) 16 (53) 0.039
 Lacunar, n (%) 7 (22) 14 (47)
Data expressed as mean ± standard deviation or number (percentage). Significance determined by t-test. Chi-squared used for: anti-hypertensive use, male gender, dipping status and stroke type.
Copyright
© 2019 Association for Research into Arterial Structure and Physiology. Publishing services by Atlantis Press International B.V.
Open Access
This is an open access article distributed under the CC BY-NC 4.0 license (http://creativecommons.org/licenses/by-nc/4.0/).

Journal
Artery Research
Volume-Issue
25 - Supplement 1
Pages
S155 - S155
Publication Date
2020/02/17
ISSN (Online)
1876-4401
ISSN (Print)
1872-9312
DOI
10.2991/artres.k.191224.141How to use a DOI?
Copyright
© 2019 Association for Research into Arterial Structure and Physiology. Publishing services by Atlantis Press International B.V.
Open Access
This is an open access article distributed under the CC BY-NC 4.0 license (http://creativecommons.org/licenses/by-nc/4.0/).

Cite this article

TY  - JOUR
AU  - Fran Kirkham
AU  - GN Nuredini
AU  - A Saunders
AU  - Erin Drazich
AU  - Eva Bunting
AU  - Philip Rankin
AU  - K Ali
AU  - M Okorie
AU  - Chakravarthi Rajkumar
PY  - 2020
DA  - 2020/02/17
TI  - P115 Does Post-stroke White Coat Hypertension/Effect (WCH/E) Require Intensive Blood Pressure Management?
JO  - Artery Research
SP  - S155
EP  - S155
VL  - 25
IS  - Supplement 1
SN  - 1876-4401
UR  - https://doi.org/10.2991/artres.k.191224.141
DO  - 10.2991/artres.k.191224.141
ID  - Kirkham2020
ER  -