Nocturnal blood pressure dipping in acute ischemic stroke

Objectives We aim to assess the impact of early nocturnal blood pressure ( BP ) variation in the functional outcome of patients after an acute ischemic stroke. Materials and methods We included consecutive stroke patients treated with intravenous thrombolysis ( IV rt PA ) in a tertiary stroke center. BP measurements were performed at regular intervals throughout day and night during the first 48 h after stroke onset, and subjects were divided into four dipping categories (extreme dippers, dippers, non‐dippers, and reverse dippers). Recanalization was assessed by transcranial color‐coded Doppler and/or angiographic CT . Hemorrhagic transformation was evaluated at 24 h follow‐up CT scan. Functional outcome was evaluated at 3 months after stroke using the modified Rankin Scale. Results A total of 304 patients were included, mean age 72.80 ± 11.10 years. After 24 h of systolic BP monitoring, 30.59% were classified as reverse dippers, 39.14% as non‐dippers, 19.10% as dippers, and 11.18% as extreme dippers. Multivariate analysis did not show an independent association of any dipping class with 3‐month functional outcome. Hemorrhagic transformation was not uniform between dipping classes: 25.81% for reverse dippers, 14.29% for non‐dippers, 15.52% for dippers, and 5.88% for extreme dippers, P  = 0.033. Conclusions Nocturnal BP dipping pattern is not associated with functional outcome at 3 months in acute stroke patients treated with IV rt PA . Hemorrhagic transformation was more frequent in reverse dippers.