Blood pressure monitoring in the assessment of old patients with acute stroke

Background Most patients have elevated blood pressure in the early phase of acute stroke that it often returns to normal within approximately seven-days. Most available data on the pattern of blood pressure in acute stroke are based on manual blood pressure measurements. Aims The aims of the present study were to assess with 24h blood pressure monitoring the pattern of blood pressure in acute stroke, and the change in blood pressure during the first week of event in very old patients. Methods We studied 99 patients with acute stroke (58 males), mean age 83 ± 6 years (range 70-97). Casual blood pressure and 24h blood pressure monitoring were recorded within 24h of admission, and then after six- to seven-days. Results Casual blood pressure before beginning the 24h blood pressure monitoring was 154 ± 23/80 ± 15mmHg and the average 24h blood pressure was 147 ± 20/74 ± 11mmHg. One-week after stroke, casual blood pressure decreased by 15/7mmHg, whereas 24h blood pressure decreased by only 7/2mmHg (P<0·01). Blood pressure decreased remarkably only in those with admission elevated systolic blood pressure. The change in 24h systolic blood pressure after one-week correlated to the 24h admission systolic blood pressure (R=0·47; P<0·01). Conclusions Casual blood pressure may overestimate blood pressure in stroke patients. Very old patients with stroke exhibit a mild increase in blood pressure during the acute phase, and blood pressure decreases spontaneously only in those with elevated blood pressure levels. Use of 24h blood pressure monitoring may be helpful in elderly patients with acute stroke.