P116 Post-stroke White Coat Hypertension/Effect is Associated with Greater Arterial Stiffness

• Main Authors: Fran Kirkham, A Saunders, GN Nuredini, E Drazich, Philip Rankin, E Bunting, K Ali, M Okorie, C Rajkumar
• Format: Article
• Language: English
• Published: Atlantis Press 2020-02-01
• Series: Artery Research
• Online Access: https://www.atlantis-press.com/article/125934588/view

Objective: White coat hypertension/effect (WCH/E) describes an elevated clinic blood pressure (BP) with normal daytime ambulatory BP (ABPM) values. It is not clear whether WCH/E is associated with adverse vascular risk. This study aimed to determine the relationship between WCH/E and arterial stiffness in a cohort of patients who had a transient ischaemic attack (TIA) or lacunar stroke (LS). Design and Method: The Arterial Stiffness In Lacunar Stroke and TIA (ASIST) study recruited 96 patients, aged over 40 years old, with a confirmed diagnosis of TIA or LS in the preceding 14 days. Patients were grouped by BP. Thirty-four patients were excluded (n = 6 declined ABPM, n = 3 masked hypertension and 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. Arterial stiffness was measured using carotid-femoral pulse wave velocity (PWV), (Complior®, ALAM Medical) and carotid-ankle vascular index (CAVI), (VaSera VS-1500 N®, Fukuda Denshi). Results: Compared to patients with normal BP, patients with WCH/E were older, had a higher body mass index (BMI) and higher arterial stiffness measured by CAVI (10.3 ± 1.3 vs 9.4 ± 1.7, p = 0.027), and PWV (11.9 ± 3.0 vs 9.6 ± 2.3 ms−1, p = 0.002). The WCH/E cohort had more lacunar strokes (p = 0.039). Conclusion: In this population of post-stroke patients, those with WCH/E had greater arterial stiffness and a higher prevalence of lacunar stroke. These results suggest that WCH/E is associated with adverse cardiovascular risk. Normotension (N = 32) WCH/E (N = 30) Statistical 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 systolic BP (mmHg) 125 ± 9 155 ± 13 <0.001 Clinic diastolic BP (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 CAVI 9.4 ± 1.7 10.3 ± 1.3 0.027 PWV (ms−1) 9.6 ± 2.3 11.9 ± 3.0 0.002 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, gender and stroke type.