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. 2023 Jul 21;12(14):4816.
doi: 10.3390/jcm12144816.

Midday Dipping and Circadian Blood Pressure Patterns in Acute Ischemic Stroke

Nikolaos Kakaletsis  1 , George Ntaios  2 , Haralampos Milionis  3 , Anastasia Karagiannaki  2 , Ioanna Chouvarda  4 , Vasiliki Dourliou  1 , Ioannis Ladakis  4 , Georgia Kaiafa  1 , Konstantinos Vemmos  5 , Christos Savopoulos  1
Affiliations

Midday Dipping and Circadian Blood Pressure Patterns in Acute Ischemic Stroke

Nikolaos Kakaletsis et al. J Clin Med. .

Abstract

The purpose of this study was to investigate the alterations in blood pressure (BP) during midday and the changes in circadian BP patterns in the acute phase of ischemic stroke (AIS) with the severity of stroke and their predictive role outcomes within 3 months. A total of 228 AIS patients (a prospective multicenter follow-up study) underwent 24 h ambulatory blood pressure monitoring (ABPM). Mean BP parameters during the day (7:00-22:59), the midday (13:00-16:59), and the night (23:00-6:59), and midday and nocturnal dipping were calculated. Midday SBP dippers had less severe stroke, lower incidence of hypertension and SBP/DBP on admission, lower levels of serum glucose and WBCs, and delayed initiation of ABPM compared to risers. There was a reverse relation between midday SBP dipping and both nocturnal dipping and stroke severity. The "double dippers" (midday and nocturnal dipping) had the least severe stroke, the lowest SBP/DBP on admission, the lowest heart rate from ABPM, and a lower risk of an unfavorable outcome, while the "double risers" had the opposite results, by an approximately five-fold risk of death/disability at 3 months. These findings indicate different circadian BP patterns during the acute phase of AIS, which could be considered a marker of stroke severity and prognosis.

Keywords: acute ischemic stroke; circadian blood pressure patterns; midday dipping; nocturnal dipping; outcome.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Scatterplot of the relationship between midday and nocturnal SBP dipping derived from the ABPM of all study participants.
Figure 2
Figure 2
Circadian variation in mean systolic blood pressure (SBP) with 95% CI of all study participants in the four different SBP circadian pattern groups: (A) midday and nocturnal dipping (“double dippers”); (B) midday dipping and nocturnal rise; (C) midday rise and nocturnal dipping, and (D) midday and nocturnal rise (“double risers”). Yellow: Midday time (13:00–16:59); Red: Night-time (23:00–6:59); Red dashed line: Mean systolic blood pressure of all study participants without prior disability (149.8 mmHg).
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References

    1. Zhong G., Wang Y., Tao T., Ying J., Zhao Y. Daytime napping and mortality from all causes, cardiovascular disease, and cancer: A meta-analysis of prospective cohort studies. Sleep Med. 2015;16:811–819. doi: 10.1016/j.sleep.2015.01.025. - DOI - PubMed
    1. Stergiou G.S., Malakos J.S., Zourbaki A.S., Achimastos A.D., Mountokalakis T. Blood pressure during siesta: Effect on 24-h ambulatory blood pressure profiles analysis. J. Hum. Hypertens. 1997;11:125–131. doi: 10.1038/sj.jhh.1000383. - DOI - PubMed
    1. Stergiou G.S., Vemmos K.N., Pliarchopoulou K.M., Synetos A.G., Roussias L.G., Mountokalakis T.D. Parallel Morning and Evening Surge in Stroke Onset, Blood Pressure, and Physical Activity. Stroke. 2002;33:1480–1486. doi: 10.1161/01.STR.0000016971.48972.14. - DOI - PubMed
    1. Trichopoulos D., Tzonou A., Christopoulos C., Havatzoglou S., Trichopoulou A. Does a siesta protect from coronary heart disease? Lancet. 1987;2:269–270. doi: 10.1016/S0140-6736(87)90848-8. - DOI - PubMed
    1. Kalandidi A., Tzonou A., Toupadaki N., Lan S.-J., Koutis C., Drogari P., Notara V., Hsieh C.-C., Toutouzas P., Trichopoulos D. A Case-Control-Study of Coronary Heart Disease in Athens, Greece. Int. J. Epidemiol. 1992;21:1074–1080. doi: 10.1093/ije/21.6.1074. - DOI - PubMed

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