| Summary: | 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.
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.
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