Abnormal Blood Pressure Circadian Rhythm in Acute Ischaemic Stroke: are Lacunar Strokes Really Different?

Castilla-Guerra, Luis; Espino-Montoro, Antonio; Fernández-Moreno, M.C.; López-Chozas, José Manuel

doi:10.1111/j.1747-4949.2009.00314.x

Cited by 27 publications

(25 citation statements)

References 25 publications

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“…There was no long-term follow-up. 3,[20][21][22][23][24][25] In the present study, we examined very old patients with acute stroke and used both admission casual BP levels and 24H BPM. Previous studies have demonstrated contradictory results regarding the effect of admission BP levels on outcomes in patients with acute stroke.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have demonstrated contradictory results regarding the effect of admission BP levels on outcomes in patients with acute stroke. 5,13,14,[19][20][21][22][23][24][25][26] All studies evaluated a short-term (maximum 6 months) outcome. We did not observe any effect of admission BP levels on short-or long-term outcome, which may be related to the older age of our study group or to the fact that admission BP did not represent true BP levels.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Systolic Blood Pressure During Acute Stroke Is Associated With Functional Status and Long-term Mortality in the Elderly

Weiss

Beloosesky

Kenett

et al. 2013

Stroke

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Awareness of the impact of BP levels during acute stroke on the short-and long-term outcome is crucial for the management of these patients. We, therefore, designed a study to evaluate the impact of admission BP levels assessed by casual BP measurements and 24H BPM on short-and long-term outcome in very elderly stroke patients. Subjects and Methods Study PopulationAll study patients were consecutively admitted to an acute geriatric ward with acute stroke between May 15, 2007, and March 15, 2011, and evaluated on admission. Subjects were included if they had had a documented acute stroke within 24 hours before admission. Ischemic stroke and intracranial hemorrhage were diagnosed by clinical findings and head computerized tomography. Patients <70 years of age, and patients with transient ischemic attacks, or other causes of acute neurological deficit were excluded. Further exclusions included patients Background and Purpose-The prognostic value of blood pressure (BP) levels during acute stroke has not been adequately studied. Most studies do not use continuous BP measurements, and patients are followed only for a short period. We designed a study to assess, with 24-hour BP monitoring (24H BPM), the impact of BP levels during the first day of stroke, on the short-term functional status and long-term mortality in elderly patients. Methods-We studied 177 patients with acute stroke (89 men), mean age 84±6 years. BP was measured on admission and 24H BPM was recorded within 24 hours of admission. After 7 days, patients were assessed for functional status according to the modified Rankin Scale and were subsequently followed up for mortality ≤5 years (mean, 2.07±1.48). Results-After 7 days, functional status improved and modified Rankin Scale decreased from 4.2 to 3.7. Follow-up analysis disclosed that 71 patients (27 men and 44 women) had died. Mortality rate was higher in women (50% versus 30%; P<0.01) and in patients with a history of congestive heart failure. Only average systolic BP, recorded by 24H BPM, predicted short-term functional status and long-term mortality. Cox proportional hazards model analysis demonstrated that age, sex, congestive heart failure, and average systolic BP >160 mm Hg, recorded by 24H BPM, were associated with increased mortality. Conclusions-High systolic BP recorded by 24H BPM on the first day of stroke was found to be associated with unfavorable short-term functional status and long-term mortality in elderly patients. (Stroke. 2013;44:2434-2440.)

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Systolic Blood Pressure During Acute Stroke Is Associated With Functional Status and Long-term Mortality in the Elderly

Weiss

Beloosesky

Kenett

et al. 2013

Stroke

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“…Patients with lacunar strokes tend to show this secondary worsening of stroke symptoms more often than patients with cortical strokes [1]. A hypothesis is that some stroke patients, mainly with lacunar stroke and premorbid hypertension, show extreme nocturnal blood pressure falls or just no nocturnal blood pressure falls at all [1,2,4,9,10]. Nocturnal blood pressure falls of 10-15 mmHg are physiological.…”

Section: Introductionmentioning

confidence: 97%

Searching for prognostic variables for secondary worsening after ischaemic stroke

et al. 2010

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Secondary worsening of stroke symptoms is described in 13-37% of stroke patients, but the exact mechanism of this phenomenon remains unclear. The aim of this study is to find prognostic variables in correlation to secondary worsening of stroke symptoms in patients with lacunar or cortical strokes. In this prospective observational study we included all patients with ischaemic stroke; patients with transient ischaemic attack were excluded. Patients undergoing thrombolysis and becoming symptom-free after 24 h were still included in our analyses. Secondary worsening of stroke symptoms was defined as an increase of two or more points on the NIH Stroke Scale (NIHSS). The NIHSS score was assessed on admission, at discharge, and when patients had symptoms that indicated worsening of stroke. Applying univariate and multivariable analysis, we studied the relation between symptoms indicating secondary worsening of stroke and prognostic variables such as extreme nocturnal blood pressure falls (>20% of the average blood pressure), infection, diabetes mellitus, hypertension, smoking, dyslipidaemia, a history of cardiovascular or cerebrovascular disease and thrombolysis. This study included 202 patients with a mean age of 72 years, 48.8% were men and 43% had a lacunar stroke. Secondary worsening of stroke symptoms occurred in 13.5% of all patients, more often but not significantly (NS) after lacunar than cortical strokes (16.8 and 11.4%, respectively), and in patients with extreme nocturnal blood pressure falls versus without (15.6 and 11.8%, respectively (NS)). There was no significant relation between the analysed prognostic variables and secondary worsening of stroke symptoms. This study did not show significant correlation between several variables and secondary worsening of stroke symptoms in patients with recent ischaemic stroke.

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“…Vascular risk factors of LS and NLS relate directly to the underlying etiologies of the two subtypes (Kazui et al, 2000;Khan et al, 2012;Park et al, 2012). However, relatively little is known of the non-vascular risk factors contributing to ischemic stroke (Petty et al, 2000;Cokar et al, 2008;Prodan et al, 2008;Castilla-Guerra et al, 2009;Jackson et al, 2010;Zhang et al, 2011). Identifying the risk factors of ischemic stroke and the determinants of outcome (stroke recurrence and mortality) after onset of stroke is the basis for stroke prevention strategies.…”

Section: Introductionmentioning

confidence: 99%

Distinct non-cerebrovascular risk factors for ischemic lacunar stroke and non-lacunar stroke: preliminary results

Chen¹,

Luo²,

Liu³

et al. 2015

Genet. Mol. Res.

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ABSTRACT. Stroke is a non-communicable disease of increasing socioeconomic importance in aging populations. This study compared the risk factors implicated in two subtypes of ischemic stroke: lacunar stroke (LS) and non-lacunar stroke (NLS). A retrospective case control study was conducted on a total of 368 patients [220 cases (59.8%) of NLS and 148 cases (40.2%) of LS] with first-time onset of ischemic stroke. Multivariate logistic regression was performed to compare multiple non-cerebrovascular risk factors between the two groups. More patients with a history of diabetes were found in the NLS than the LS group (40.5 vs 26.4%), and that both fasting glucose and HbA1C levels before the onset of stroke were higher in NLS than LS patients. Multivariate analysis revealed that patients with a history of diabetes were 1.57 times more likely to have NLS than LS (OR = 1.57, 95%CI = 0.95-3.26). Moreover, male patients were more likely to develop Ischemic lacunar stroke and non-lacunar stroke NLS than females (OR = 1.46, 95%CI = 0.79-2.69), and patients with elevated fibrinogen levels were 1.4 times more likely to develop NLS than LS (OR = 1.40, 95%CI = 1.09-1.80). Additionally, patients who were heavy drinkers (OR = 1.39, 95%CI = 0.68-2.84) or smokers (OR = 1.62, 95%CI = 0.91-2.89) were more likely to develop NLS than LS. Other risk factors, such as hypertension, dyslipidemia, age, and average blood pressure, did not differ between the two types of stroke. Thus, distinct non-cerebrovascular risk factors (male gender, long history of diabetes, elevated fibrinogen, heavy smoking, and heavy drinking) are associated with a higher risk of developing non-lacunar stroke than lacunar stroke.

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Abnormal Blood Pressure Circadian Rhythm in Acute Ischaemic Stroke: are Lacunar Strokes Really Different?

Cited by 27 publications

References 25 publications

Systolic Blood Pressure During Acute Stroke Is Associated With Functional Status and Long-term Mortality in the Elderly

Systolic Blood Pressure During Acute Stroke Is Associated With Functional Status and Long-term Mortality in the Elderly

Searching for prognostic variables for secondary worsening after ischaemic stroke

Distinct non-cerebrovascular risk factors for ischemic lacunar stroke and non-lacunar stroke: preliminary results

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