Association of reverse dipping blood pressure with mortality among critically ill patients with ischemic stroke

Abstract

Reverse dipping blood pressure, generally regarded as a pathological condition, is frequently observed in patients with acute stroke. We aimed to assess the association of reverse dipping blood pressure with in-hospital mortality among critically ill patients with ischemic stroke. This is a retrospective study of patients in the Medical Information Mart for Intensive Care IV database with ischemic stroke requiring intensive care unit admission. Diurnal (9:00-21:00) and nocturnal (1:00-6:00) mean arterial pressures (MAPs) were collected. Reverse dipping was defined as having an average nocturnal MAP higher than the average diurnal MAP. Multivariable binary logistic regression analysis was used to assess the association of reverse dipping with in-hospital mortality. A total of 2080 patients (median age, 73 years; 50.3% female) were enrolled, among which 681 patients (32.7%) had reverse dipping. Patients with reverse dipping blood pressure had a higher in-hospital mortality compared to those without (19.8% vs. 11.4%, p < 0.001). After adjusting for potential confounders, reverse dipping was associated with a higher likelihood of in-hospital mortality (adjusted OR, 1.59; 95% CI 1.21-2.11; p = 0.001). Reverse dipping blood pressure was associated with a higher mortality rate among critically ill patients with ischemic stroke. The circadian rhythm of blood pressure should warrant more attention in cerebrovascular neurocritical care.

Keywords: Blood pressure; Circadian rhythm; Ischemic stroke; Mortality; Reverse dipping.