Blood pressure (BP) variability and circadian BP patterns may influence long-term outcomes after acute ischemic stroke, but their prognostic significance remains incompletely defined. A study presented at the ESH Congress 2026 evaluated BP phenotypes and day-night BP variability during the acute phase of ischemic stroke and assessed associations with 10-year cardiovascular death.

The prospective study included 85 patients with acute ischemic stroke who underwent 24-hour ambulatory blood pressure monitoring (ABPM) during the first 3 days after symptom onset. Long-term outcomes were assessed by telephone follow-up approximately 10 years after the index event.

Findings

• A non-dipping nocturnal BP pattern was the predominant circadian profile, observed in 89.3%, 89.2%, and 88.3% of patients on Days 1, 2, and 3, respectively.
• Sustained hypertension was the only reproducible BP phenotype across serial assessments, occurring in 50.0%, 45.8%, and 51.6% of patients across the first 3 days after stroke.
• Mean follow-up duration was 509.6±10 weeks, during which 37.1% of patients died.
• Major adverse cardiovascular events accounted for 41.2% of deaths during follow-up.
• Sustained hypertension (OR, 2.78; 95% CI, 1.13–6.83), day-night systolic BP ratio (OR, 0.98; 95% CI, 0.96–0.99), and day-night diastolic BP ratio (OR, 0.96; 95% CI, 0.94–0.99) predicted cardiovascular death.

The findings suggest that non-dipping BP patterns are highly prevalent during the acute phase of ischemic stroke, while sustained hypertension remains the most reproducible BP phenotype. Day-night BP variability also appeared to carry prognostic significance for long-term cardiovascular mortality.