Blood pressure changes in acute stroke — The West Birmingham stroke project

‘Reverse dipping’ on ambulatory blood pressure monitoring

“…2,5 In the West Birmingham Stroke Project, we found that patients with intracerebral haemorrhage had the highest daytime blood pressures by ABPM; and a trend towards even higher blood pressures at night. 3 This phenomenon of 'reverse dipping' has not been previously reported in other patient groups, and may perhaps reflect the high blood pressures and lack of diurnal variation in stroke patients with intracerebral haemorrhage. Nevertheless, we illustrate a case of 'reverse dipping' which we recently encountered in a woman with pre-eclampsia ( Figure 1).…”

“…1,2 We have recently reported that stroke patients can also be classified as non-dippers, which may be related to the known diurnal variation of the onset of acute stroke and heart attacks. 3,4 The exact significance of 'dippers' and 'non-dippers' is unclear. The absence of a nocturnal fall in blood pressure may simply be due to the patient not sleeping or being disturbed by the inflation of the ABPM cuff.…”

Circadian blood pressure variation after acute stroke

“…The loss of nocturnal fall has been reported previously in acute stroke, and has been seen in both ischaemic and haemorrhagic stroke. [4][5][6][7][8] The normal nocturnal fall in BP is, in part, determined by changes in sympathetic activity. 1 The loss of nocturnal fall and the rise in nocturnal BP has been associated with an increase in plasma norepinephrine levels, indicating an alteration in modulation of the sympathetic nervous system.…”

“…Previous studies of abnormal BP variability patterns in acute stroke looked at only one dipping pattern, either non-dipping or reverse dipping. [4][5][6][7][8] Previous researchers have also tried to link changes in circadian BP variability with different stroke subtypes, although results have been conflicting. For example, in different studies non-dipping has been shown to be associated with ischaemic stroke, haemorrhage, and to show no association with stroke type.…”

“…For example, in different studies non-dipping has been shown to be associated with ischaemic stroke, haemorrhage, and to show no association with stroke type. [4][5][6][7] The influence of abnormal circadian BP patterns on stroke outcome is also unclear. Some studies have found poor outcome among reverse dippers 9 and non-dippers, 10 while others have noted no association between the different patterns of circadian BP variation and outcome.…”