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March 13, 2002

Circadian Variability in Hemorrhagic Stroke

JAMA. 2002;287(10):1266-1267. doi:10-1001/pubs.JAMA-ISSN-0098-7484-287-10-jlt0313

To the Editor: Circadian patterns have been shown in several acute hemorrhagic events, and such patterns could be related to blood pressure rhythms.1

We reviewed the records of all patients admitted for intracerebral hemorrage (IH) to the Hospital of Ferrara, Italy, from 1994 through 1997. The diagnosis of IH in 258 patients (136 men, 122 women) was based on either computed tomography, magnetic resonance imaging, or autopsy. Stroke onset time was defined as the earliest time at which definite symptoms or signs were noted, as systematically obtained from patients or bystanders. Precise determination of the onset time was possible in 215 cases (113 men, 102 women; mean age, 73 y). For an additional 26 patients, onset time could not be determined exactly but it could be assigned to 1 of 4 periods: 12:01 AM to 6:00 AM, 6:01 AM to 12:00 PM, 12:01 PM to 6:00 PM, and 6:01 PM to 12:00 AM. The time of onset was unknown for the remaining 17 patients, who were excluded. We classified 68 patients as "hypertensive" if they were taking antihypertensive medications at the time of their stroke, or if they had 3 separate blood pressure measurements greater than 140/90 mm Hg in the previous years. This information was available for all patients.