Association of Ambulatory Blood Pressure Monitoring parameters with the Framingham Stroke Risk Profile

The Framingham Stroke Risk Profile (FSRP) is a novel and reliable tool for estimating the 10-year probability for incident stroke in stroke-free individuals, while the predictive value of ambulatory blood pressure monitoring (ABPM) for first-ever and recurrent stroke has been well established. We sought to evaluate cross-sectionally the association of ABPM parameters with FSRP score in a large sample of 2343 consecutive stroke-free individuals (mean age: 56.0 +/- 12.9, 49.1% male) who underwent 24-hour ABPM. True hypertensives showed significantly higher FSRP (11.2 +/- 5.0) compared to the normotensives (8.2 +/- 5.0, p <0.001), while subjects with white coat hypertension also had higher FSRP (102 4.7) than normotensives (8.2 +/- 5.0, p < 0.001). Compared to dippers that exhibited the lowest FSRP, non-dippers and reverse-dippers exhibited significantly higher FSRP (9.8 +/- 4.8 for dippers vs 10.6 +/- 52 and 11.5 +/- 5.0 for non-dippers and reverse -dippers respectively, p 0.001 for comparisons). In univariate analyses, the ABPM parameters that had the strongest correlation with FSRP were 24 hour (r = 0.440, p < 0.001), daytime (r = 0.435, p < 0.001) and night-time (r = 0.423; p <0.001) pulse pressure (PP). The best fitting model for predicting FSRP (R-2 = 24.6%) on multiple linear regression analyses after adjustment for vascular risk factors not included in FSRP comprised the following parameters in descending order: 24 hour PP (beta = 0.349, p < 0.001), daytime SBP variability (beta = 0.124, p < 0.001), 24-hour HR variability (beta = 0.091, p < 0.001), mean 24 -hour HR (beta = 0.107, p <0.001), BMI (beta = 0.081, p <0.001) and dipping percentage (beta = 0.063, p = 0.001). 24-hour PP and daytime SBP variability are the two ABPM parameters that were more strongly associated with FSRP-score. Reverse dippers had the highest FSRP among all dipping status profiles. (C) 2017 Elsevier B.V. All rights reserved.