Objective To explore the clinical predictive value of 24-hour ambulatory blood pressure monitoring (ABPM) for short-term progression to cerebral infarction in patients with transient ischemic attack (TIA) and hypertension, in order to provide a new basis for early identification of TIA progression and individualized intervention.

Methods A total of 1 276 TIA patients with hypertension who were admitted to Cangzhou Central Hospital from January 2021 to June 2025 were included. The patients were categorized into cerebral infarction group and non-cerebral infarction group according to whether the patient had progressed to acute cerebral infarction within 90 days of follow-up. Comparative analysis was conducted on general clinical data and ABPM indices. Multivariate logistic regression analysis was employed to assess the variables influencing the progression from TIA to cerebral infarction. Additionally, receiver operating characteristic (ROC) curve analysis was utilized to assess the predictive capacity of blood pressure indices for TIA progression to cerebral infarction.

Results There were significant differences in hypertension grade and circadian blood pressure rhythm classification between non-cerebral infarction group and cerebral infarction group (P＜0.05). The duration of hypertension, as well as the proportion of H-type hypertension, 24-hour systolic blood pressure (24hSBP), 24-hour diastolic blood pressure (24hDBP), daytime systolic blood pressure (dSBP), daytime diastolic blood pressure (dDBP), nighttime systolic blood pressure (nSBP), coefficients of variation (CV) of 24hSBP (24hSBP-CV), 24hDBP-CV, dSBP-CV, nSBP-CV, and ABCD2 scores were significantly higher in the cerebral infarction group compared to the non-cerebral infarction group (P＜0.05). Logistic regression analysis revealed that H-type hypertension, duration of hypertension, circadian blood pressure rhythm classification, 24hSBP, dSBP, dDBP, nSBP, 24hSBP-CV, 24hDBP-CV, dSBP-CV, nSBP-CV, and ABCD2 score were independent risk factors for the progression of TIA to cerebral infarction (P＜0.05). The ROC curve analysis demonstrated that the areas under the curve (AUCs) (95%CI) for H-type hypertension, duration of hypertension, circadian blood pressure rhythm classification, 24hSBP, dSBP, dDBP, nSBP, 24hSBP-CV, 24hDBP-CV, dSBP-CV, nSBP-CV, and ABCD2 score were 0.636 (0.603 to 0.669), 0.629 (0.594 to 0.663), 0.646 (0.612 to 0.679), 0.603 (0.570 to 0.636), 0.586 (0.552 to 0.619), 0.557 (0.524 to 0.590), 0.608 (0.575 to 0.642), 0.680 (0.648 to 0.712), 0.545 (0.510 to 0.579), 0.728 (0.698 to 0.758), 0.627 (0.593 to 0.660), 0.685 (0.655 to 0.715) respectively. The AUC (95%CI) for the combined index was 0.898 (0.880 to 0.918).

Conclusions  H-type hypertension, duration of hypertension, rhythm classification of hypertension, 24hSBP, dSBP, dDBP, nSBP, 24hSBP-CV, 24hDBP-CV, dSBP-CV, nSBP-CV, and ABCD2 score are related to the progression of TIA to cerebral infarction. The combination of these indexes has high clinical application value in judging the progression of TIA to cerebral infarction.