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Ambulatory blood pressure monitoring among patients with cerebrovascular disease.
Sico JJ, Phipps MS, Yaggi HK, Burrus N, Ferguson J, McClain V, Austin C, Li X, Bravata DM. Ambulatory blood pressure monitoring among patients with cerebrovascular disease. Blood pressure monitoring. 2011 Oct 1; 16(5):211-7.
Although stroke care guidelines endorse the paramount importance of hypertension management, the specific role of ambulatory blood pressure (ABP) monitoring among patients with cerebrovascular disease has not been established.
The objectives of this study were to: (a) conduct a systematic review describing the published studies that examined ABP monitoring among patients with cerebrovascular disease and (b) to discuss practical considerations of ABP monitoring among patients with stroke.
We identified English-language articles that focused on the use of ABP monitoring among patients with cerebrovascular disease. The titles and abstracts of the articles were reviewed to identify whether the study included ABP monitoring and whether the populations studied had evidence of cerebrovascular disease; we excluded two case reports. We used ABP data from patients with cerebrovascular disease enrolled in an ongoing clinical trial to illustrate points related to the application of ABP monitoring in this population.
A total of 23 articles met our inclusion criteria. These articles described the use of ABP monitoring for the identification of stroke patients at risk of poor outcomes, including mortality and neurological impairment. They also describe common patterns of blood pressure poststroke; finding that stroke patients often demonstrate a loss of the usual nocturnal fall in blood pressure. Logistical considerations in the use of ABP monitoring for patients with stroke include patients with arm weakness, the minimum number of measurements needed, the determination of nocturnal/rest versus daytime/wake blood pressure values, and the interpretation of extreme values are reviewed.
Until controlled trial data support interventions based on the ABP data, it is unlikely that guidelines will recommend the routine application of ABP monitoring among patients with stroke.