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), 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.

Table 1