24-hour ambulatory blood pressure and cryptogenic ischemic stroke in young adults

the SECRETO Study Group, Lauri Tulkki, Nicolas Martinez-Majander, Petri Haapalahti, Heli Tolppanen, Juha Sinisalo, Olli Repo, Tomi Sarkanen, Heikki Numminen, Essi Ryödi, Pauli Ylikotila, Risto O. Roine, Riikka Lautamäki, Antti Saraste, Tuuli Miettinen, Jaana Autere, Pekka Jäkälä, Marja Hedman, Juha Huhtakangas, Ulla JunttolaJukka Putaala, Jani Pirinen

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Background: In young patients, up to 40% of ischemic strokes remain cryptogenic despite modern-day diagnostic work-up. There are limited data on blood pressure (BP) behavior in these patients. Thus, we aimed to compare ambulatory blood pressure (ABP) profiles between young patients with a recent cryptogenic ischemic stroke (CIS) and stroke-free controls. Patients and Methods: In this substudy of the international multicenter case–control study SECRETO (NCT01934725), 24-hour ambulatory blood pressure monitoring (ABPM) was performed in consecutive 18–49-year-old CIS patients and stroke-free controls. The inclusion criteria were met by 132 patients (median age, 41.9 years; 56.1% males) and 106 controls (41.9 years; 56.6% males). We assessed not only 24-hour, daytime, and nighttime ABP but also hypertension phenotypes and nocturnal dipping status. Results: 24-hour and daytime ABP were higher among controls. After adjusting for relevant confounders, a non-dipping pattern of diastolic blood pressure (DBP) was associated with CIS in the entire sample (odds ratio, 3.85; 95% confidence interval, 1.20–12.42), in participants without antihypertensives (4.86; 1.07–22.02), and in participants without a patent foramen ovale (PFO) (7.37; 1.47–36.81). After excluding patients in the first tertile of the delay between the stroke and ABPM, a non-dipping pattern of DBP was not associated with CIS, but a non-dipping pattern of both systolic BP and DBP was (4.85; 1.37–17.10). In participants with a PFO and in those without hypertension by any definition, no associations between non-dipping patterns of BP and CIS emerged. Conclusions: Non-dipping patterns of BP were associated with CIS in the absence of a PFO but not in the absence of hypertension. This may reflect differing pathophysiology underlying CIS in patients with versus without a PFO. Due to limitations of the study, results regarding absolute ABP levels should be interpreted with caution.Key Messages Nocturnal non-dipping patterns of blood pressure were associated with cryptogenic ischemic stroke except in participants with a patent foramen ovale and in those without hypertension by any definition, which may indicate differing pathophysiology underlying cryptogenic ischemic stroke in patients with and without a patent foramen ovale. It might be reasonable to include ambulatory blood pressure monitoring in the diagnostic work-up for young patients with ischemic stroke to detect not only the absolute ambulatory blood pressure levels but also their blood pressure behavior.

Original languageEnglish
Article number2203513
Number of pages13
JournalAnnals of Medicine
Issue number1
Publication statusPublished - 2023
Publication typeA1 Journal article-refereed


  • ambulatory blood pressure monitoring
  • case–control study
  • Cryptogenic ischemic stroke
  • young adults

Publication forum classification

  • Publication forum level 2

ASJC Scopus subject areas

  • Medicine(all)


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