Background
The association between blood pressure (BP) levels and BP variability (BPV) following acute ischaemic stroke (AIS) and outcome remains controversial.

Aims
To investigate the predictive value of systolic BP (SBP) and diastolic BP (DBP) and BPV measured using 24-h ambulatory blood pressure monitoring (ABPM) methods during AIS regarding outcome.

Methods
A total of 228 AIS patients (175 without prior disability) underwent ABPM every 20 min within 48 h from onset using an automated oscillometric device (TM 2430, A&D Company Ltd) during day time (7:00–22:59) and night time (23:00–6:59). Risk factors, stroke subtypes, clinical and laboratory findings were recorded. Mean BP parameters and several BPV indices were calculated. End-points were death and unfavourable functional outcome (disability/death) at 3 months.

Results
A total of 61 (26.7%) patients eventually died. Multivariate logistic regression analysis revealed that only mean night-time DBP (hazard ratio (HR): 1.04; 95% confidence interval (CI): 1.00–1.07) was an independent prognostic factor of death. Of the 175 patients without prior disability, 79 (45.1%) finally met the end-point of unfavourable functional outcome. Mean 24-h SBP (HR: 1.03; 95% CI: 1.00–1.05), day-time SBP (HR: 1.02; 95% CI: 1.00–1.05) and night-time SBP (HR: 1.03; 95% CI: 1.01–1.05), SBP nocturnal decline (HR: 0.93; 95% CI: 0.88–0.99), mean 24-h DBP (HR: 1.08; 95% CI: 1.03–1.13), day-time DBP (HR: 1.07; 95% CI: 1.03–1.12) and night-time DBP (HR: 1.06; 95% CI: 1.02–1.10) were independent prognostic factors of an unfavourable functional outcome.

Conclusions
In contrast with BPV indices, ABPM-derived BP levels and lower or absence of BP nocturnal decline in the acute phase are prognostic factors of outcome in AIS patients.