Physiological Correlates of Beat-to-Beat, Ambulatory, and Day-to-Day Home Blood Pressure Variability After Transient Ischemic Attack or Minor Stroke

Abstract Background Elevated blood pressure (BP) at emergency department (ED) presentation and advancing age have been associated with risk of ischemic stroke; however, the relationship between BP, age, and transient ischemic attack/minor stroke (TIA/MS) is not clear. Methods A multi-site, prospective, observational study of 1084 ED patients screened for suspected TIA/MS (symptom onset < 24 h, NIHSS< 4) between December 2013 and April 2016. Systolic and diastolic BP measurements (SBP, DBP) were taken at ED presentation. Final diagnosis was consensus adjudication by stroke neurologists; patients were diagnosed as either TIA/MS or stroke-mimic (non-cerebrovascular conditions). Conditional inference trees were used to define age cut-points for predicting binary diagnosis (TIA/MS or stroke-mimic). Logistic regression models were used to estimate the effect of BP, age, sex, and the age-BP interaction on predicting TIA/MS diagnosis. Results Over a 28-month period, 768 (71%) patients were diagnosed with TIA/MS: these patients were older (mean 71.6 years) and more likely to be male (58%) than stroke-mimics (61.4 years, 41%; each p < 0.001). TIA/MS patients had higher SBP than stroke-mimics (p < 0.001). DBP did not differ between the two groups (p = 0.191). SBP was predictive of TIA/MS diagnosis in younger patients, after accounting for age and sex; an increase of 10 mmHg systolic increased the odds of TIA/MS 18% (odds ratio [OR] 1.18, 95% CI 1.00–1.39) in patients < 60 years, and 23% (OR 1.23, 95% CI 11.12–1.35) in those 60–79 years, while not affecting the odds of TIA/MS in patients ≥80 years (OR 0.99, 95% CI 0.89–1.07). Conclusions Raised SBP in patients younger than 80 with suspected TIA/MS may be a useful clinical indicator upon initial presentation to help increase clinicians’ suspicion of TIA/MS. Trial registration ClinicalTrials.gov NCT03050099 (10-Feb-2017) and NCT03070067 (3-Mar-2017). Retrospectively registered.

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Response to Letter Regarding Article, “Does Abnormal Circadian Blood Pressure Pattern Really Matter in Patients With Transient Ischemic Attack or Minor Stroke?”

Stroke ◽

10.1161/strokeaha.114.005693 ◽

2014 ◽

Vol 45 (7) ◽

Author(s):

WenWen Zhang ◽

Dominique A. Cadilhac ◽

Helen M. Dewey

Keyword(s):

Blood Pressure ◽

Transient Ischemic Attack ◽

Minor Stroke ◽

Pressure Pattern ◽

Circadian Blood Pressure ◽

Ischemic Attack

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Letter by Castilla-Guerra and Fernandez-Moreno Regarding Article, “Does Abnormal Circadian Blood Pressure Pattern Really Matter in Patients With Transient Ischemic Attack or Minor Stroke?”

Stroke ◽

10.1161/strokeaha.114.005629 ◽

2014 ◽

Vol 45 (7) ◽

Cited By ~ 3

Author(s):

Luis Castilla-Guerra ◽

María del Carmen Fernandez-Moreno

Keyword(s):

Blood Pressure ◽

Transient Ischemic Attack ◽

Minor Stroke ◽

Pressure Pattern ◽

Circadian Blood Pressure ◽

Ischemic Attack

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Validation and comparison of Diagnosis of TIA (DOT) score as a new clinical diagnostic tool for patients with a clinical diagnosis of transient ischemic attack in China

10.21203/rs.2.1817/v1 ◽

2019 ◽

Author(s):

Junliang Yuan ◽

Zejin Jia ◽

Yangguang Song ◽

Wenli Hu

Keyword(s):

Blood Pressure ◽

Diastolic Blood Pressure ◽

Transient Ischemic Attack ◽

Demographic Data ◽

Neurological Symptoms ◽

Minor Stroke ◽

Youden Index ◽

Laboratory Findings ◽

Cerebrovascular Events ◽

Ischemic Attack

Abstract Background: Recently, [the diagnosis of transient ischemic attack (TIA), DOT) score was considered to be a new tool for non-specialists to diagnose TIA more accurately with the sensitivity and specificity were 89% and 76%. However, the DOT score has not yet been validated externally in patients with TIA in China. Methods: We prospectively enrolled consecutive 500 patients with transient neurological symptoms, who were admitted to our hospital and underwent magnetic resonance imaging (MRI) during hospitalization between Jan 2016 and Dec 2018. Patients with transient neurological symptoms were divided into two subgroups: TIA mimic group (N=140, 28%) and definite cerebrovascular events group (including tissue-based TIA (N=252, 50.4%) and minor stroke (N=108, 21.6%)). The demographic data, clinical characteristics, laboratory findings and scores of ABCD2, ABCD3-I, Dawson and DOT were compared between the two groups. Results: A total of 500 patients with transient neurological symptoms (mean age, 61.1±12.8) were enrolled and 70% (N=350) were male. Comparing with TIA mimic groups, patients with definite cerebrovascular events group were correlated with higher diastolic blood pressure, higher proportion of motor weakness and speech abnormalities, the higher levels of uric acid and homocysteine, and the scores of ABCD2, ABCD3-I, Dawson, and DOT. The logistic regression analysis showed diastolic blood pressure (OR 1.026, CI 1.006-1.046, P=0.011), ABCD3-I (OR 1.219, CI 1.032-1.440, P=0.020) and DOT (OR 1.462, CI 1.305-1.637, P=0.001) were independently predicted the occurrence of definite cerebrovascular events. The score of DOT showed the greatest area under the ROC curve (AUC=0.728), with a sensitivity of 70.3% and specificity of 62.9%, respectively. The optimal cut point for DOT was 0.455 using the Youden Index. Conclusion: Our findings showed DOT score performed relatively good calibration and discrimination. As a novel tool of TIA, further validations are needed externally in patients with TIA with multiple centers in large samples in China.

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