22. European Stroke Conference 8 Stroke prevention A 11:40 - 11:50 Identification of missed hypertension and hypertensive arteriopathy with home versus ambulatory blood pressure measurement in patients with TIA or minor stroke A.J.S. Webb1, L Li2, M Simoni3, M Wilson4, N.L.M. Paul5, U Fischer6, L Tarassenko7, P.M. Rothwell8 Stroke Prevention Research Unit, University of Oxford, Oxford, UNITED KING-DOM1, Stroke Prevention Research Unit, University of Oxford, Oxford, UNITED KINGDOM2, Stroke Prevention Research Unit, University of Oxford, Oxford, UNITED KINGDOM3, Stroke Prevention Research Unit, University of Oxford, Oxford, UNITED KINGDOM4, Stroke Pre-vention Research Unit, University of Oxford, Oxford, UNITED KINGDOM5, Stroke Preven-tion Research Unit, University of Oxford, Oxford, UNITED KINGDOM6, University of Ox-ford, Oxford, UNITED KINGDOM7, Stroke Prevention Research Unit, University of Oxford, Oxford, UNITED KINGDOM8 BACKGROUND: Hypertension is a major treatable cause of incident and recurrent stroke. However, it can be missed by one-off clinic measurements. Hypertension guidelines therefore currently recommend ambulatory monitoring (ABPM) prior to treatment in primary preven-tion. Given high rates of under-treatment of hypertension in secondary prevention after TIA and stroke, we compared Bluetooth home BP monitoring (HBPM) and ABPM in identifying hyper-tension missed at initial assessment, with validation against pre-morbid BP and markers of hy-pertensive arteriopathy. METHODS: Consecutive patients recruited to the OXVASC Study with TIA or minor stroke underwent HBPM (3 measurements, 3 times daily for 7 days) and ABPM at 1 month after pre-sentation. Mean SBP was related to premorbid hypertension (defined as mean SBP>140 or mean DBP>90 based on all BP measurements during the previous 10 years in primary care or a formal diagnosis of hypertension in primary care) and markers of hypertensive arteriopathy (creatinine, aortic stiffness - pulse wave velocity - and leukoaraiosis on brain imaging). RESULTS: Among 500 eligible patients, those with premorbid hypertension (n=307) were bet-ter identified (p<0.001) by mean SBP on HBPM than by mean awake SBP on ABPM (area un-der ROC curve: 0.73, 95%CI 0.67-0.78 vs 0.60, 0.54-0.65). This difference was also present for identification of patients (n=205) with mean pre-morbid BP>140/90 but no formal premorbid diagnosis of hypertension (0.77, 0.69-0.85 vs 0.57, 0.46-0.69), including those who were nor-motensive in the stroke clinic (0.84, 0.73-0.96 vs 0.64, 0.40-0.89). HBPM SBP was also more strongly associated than ABPM with creatinine (r=0.24, p<0.001 vs r=0.14, p=0.002), aortic stiffness (r=0.21, p=0.01 vs r=0.13, p=0.13) and moderate/severe leukoaraiosis (AUC: 0.61, 0.55-0.67 vs 0.49, 0.43-0.55). CONCLUSIONS: In patients with TIA or minor stroke, HBPM was more reliable than ABPM at identifying missed hypertension and hypertensive arteriopathy. 7 Stroke prevention A 11:30 - 11:40 Blood pressure reduction and stroke recurrence: the PROGRESS trial H. Arima1, C. Anderson2, T. Omae3, M. Woodward4, S. MacMahon5, G. Mancia6, M.-G. Bousser7, C. Tzourio8, S. Harrap9, B. Neal10, J. Chalmers11 for the PROGRESS Collaborative Group The George Institute for Global Health, University of Sydney, Sydney, AUSTRALIA1,The George Institute for Global Health, University of Sydney, Sydney, AUSTRALIA2, The National Cerebral and Cardiovascular Center, Suita, JAPAN3, The George Institute for Global Health, University of Sydney, Sydney, AUSTRALIA4, The George Institute for Global Health, Univer-sity of Sydney, Sydney, AUSTRALIA5, Universita Milano-Bicocca, Ospedale San Gerardo,, Milano, ITALY6, The Department of Neurology, Hopital Lariboisiere, Paris, FRANCE7, The University of Bordeaux, Bordeaux, FRANCE8, The Department of Physiology, University of Melbourne, Melbourne, AUSTRALIA9, The George Institute for Global Health, University of Sydney, Sydney, AUSTRALIA10, The George Institute for Global Health, University of Sydney, Sydney, AUSTRALIA11 Background: A recent observational analysis of a large-scale randomized controlled trial iden-tified a “J-curve” phenomenon such that low and high blood pressure (BP) levels are associated with increased risks of recurrent stroke among patients with recent ischaemic stroke. The ob-jective of the present analysis was to determine whether larger reduction in BP associated with treatment increases the risks of recurrent stroke among patients with cerebrovascular disease. Methods: This is a subsidiary analysis of the PROGRESS trial. A total of 6105 patients with prior stroke or transient ischaemic attack were randomly assigned to either active treatment (perindopril ± indapamide) or matching placebo(s). BP was measured at every visit and groups of participants defined by reduction in systolic BP (SBP) from baseline (<0, 0-9, 10-19 and >/=20 mmHg) were used for these analyses. Outcomes were recurrent haemorrhagic and isch-emic stroke. Results: During a mean follow-up of 3.9 years, 111 haemorrhagic and 565 ischemic stroke events were observed. There were clear inverse associations between SBP reduction and the risk of haemorrhagic stroke even after adjustment for age, sex, region, baseline SBP, diabe-tes, current smoking and randomized treatment: adjusted annual incidence rates were 0.08%, 0.06%, 0.05% and 0.03% for participant groups defined by reduction in SBP levels of <0, 0-9, 10-19 and >/=20 mmHg, respectively. Annual incidence of ischaemic stroke was 2.19%, 1.74%, 1.73% and 1.72% for the same participant groups. Compared with patients who did not achieve any SBP reduction, the decreases in the risk of ischaemic stroke were similar in the groups achieving SBP reductions of 0-9, 10-19 and >/=20 mmHg. Conclusions: The present analysis provided no evidence of increase in recurrent stroke associ-ated with larger reduction in SBP produced by BP lowering treatment among patients with cere-brovascular disease. 124 © 2013 S. Karger AG, Basel Scientific Programme
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