LAUSR

Objective: Intracranial arterial stenosis (ICAS) is a major cause of ischemic stroke. However, the associations of ICAS with home blood pressure (BP) and variability remains unclear. Design and method: Outpatients not on antihypertensive medications were recruited from 2009 to 2013. ICAS was defined if the peak systolic flow velocities measured with transcranial Doppler sonography were respectively of at least 140 cm/s, 120 cm/s, or 100 cm/s at middle, anterior, or posterior and vertical cerebaral arteries. Home BP was self-measured by Omron HEM-7051 device for seven days. BP variability was assessed as variability independent of the mean, standard deviation, maximum–minimum difference, and average real variability. Results: The prevalence of ICAS in the 801 participants (average age 51 years, 50% males) was 7.9% (63 cases). Patients with ICAS compared to those without had significantly higher clinic (135.8 vs 131.9 mmHg, P = 0.01) and home systolic BPs (134.8 vs 128.6 mmHg, P < 0.001). In multivariate-adjusted regression model, home systolic BPs, irrespective of at morning or evening, were associated with ICAS independently of other risk factors including any BP variability indices (OR, 1.47 to 1.82; P < 0.005). However, after similar adjustment including home systolic BP, ICAS was only associated with seven-day morning systolic BP variability (OR, 1.35 to 1.47; P < 0.02), neither with evening BP variability (P > 0.47), nor any day-to-day BP variability indices (P > 0.07). Conclusions: Asymptomatic ICAS was moderately prevalent in Chinese untreated patients. Both home morning and evening systolic BPs were important determinants of ICAS, and BP variability in the morning was also associated with ICAS.