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

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) 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.