Baroreflex: A New Therapeutic Target in Human Stroke?

Sýkora, Marek; Diedler, Jennifer; Turčãni, Peter; Hacke, Werner; Steiner, Thorsten

doi:10.1161/strokeaha.109.565838

Cited by 98 publications

(91 citation statements)

References 74 publications

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“…15,16 Previous studies suggest that impaired baroreflex is linked to worse clinical outcomes in patients with acute stroke. [30][31][32] Sykora et al 32 hypothesized that autonomic dysfunction in acute stroke may have unfavorable effects on outcomes via inadequate cerebral perfusion and impaired cerebral autoregulation, increased cardiovascular complications, and secondary brain injury because of inflammation, hyperglycemia, and blood-brain barrier disruption. These conditions may exacerbate brain ischemia or hamper recovery, leading to poor functional outcome after acute ischemic stroke.…”

Section: Discussionmentioning

confidence: 99%

Day-by-Day Blood Pressure Variability and Functional Outcome After Acute Ischemic Stroke

Fukuda

Kai

Kamouchi

et al. 2015

Stroke

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Therefore, BP variability in both the acute and subacute stages Background and Purpose-The relationship between blood pressure (BP) variability and functional outcome in patients with acute ischemic stroke remains unclear. This study aimed to elucidate whether in-hospital day-by-day BP variability is associated with functional outcome after acute ischemic stroke. Methods-Using the Fukuoka Stroke Registry, we included 2566 patients with a first-ever ischemic stroke who had been functionally independent before the onset and were hospitalized within 24 hours. BP was measured daily, and its variability was assessed by SD, coefficients of variance, and variations independent of mean. Poor functional outcome was assessed by modified Rankin Scale scores ≥3 at 3 months. Results-After adjustment for multiple confounding factors including age, sex, risk factors, stroke features, baseline severity, thrombolytic therapy, antihypertensive agents, and mean BP, day-by-day BP variability during the subacute stage (4-10 days after onset) was independently associated with a poor functional outcome (multivariable-adjusted odds ratios [95% confidence interval] in the top versus bottom quartile of systolic BP variability, 1.51 [1.09-2.08] for SD; 1.63 [1.20-2.22] for coefficients of variance; 1.64 [1.21-2.24] for variations independent of mean). Similar trends were also observed for diastolic BP variability. These trends were unchanged in patients who were not treated with antihypertensive drugs. In contrast, no association was found between indices of BP variability during the acute stage and functional outcome after adjusting for potential confounders. Conclusions-These data suggest that intraindividual day-by-day BP variability during the subacute stage is associated with the 3-month functional outcome after acute ischemic stroke. Fukuda et al Day-by-Day BP Variability and Stroke Outcome 1833may have clinical significance in functional outcome after acute stroke. An interval of BP fluctuations used in the previous studies ranged from beat-to-beat, hour-to-hour to day-to-night. However, the clinical significance of BP variability in cardiovascular diseases remains controversial. [14][15][16] Determinants and prognostic relevance for cardiovascular outcomes are probably different among short-term (beat-to-beat), short-term (for 24 hours), midterm (day-to-day), and long-term BP variability (visit-to-visit).15 BP fluctuations with longer intervals, including midterm and long-term BP variability, are of increasing clinical interest as predictors of end-organ damage, 17 cardiovascular events, 18-21 and mortality. 22 A recent study showed a possible association of visit-to-visit BP variability with longterm mortality after lacunar infarct. 23 However, the association between BP variability with a long interval and functional outcome after ischemic stroke is still unknown.In the present study, we calculated indices of day-by-day BP variability until the subacute stage and investigated their association with short-term clinical outcomes ...

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Section: Discussionmentioning

confidence: 99%

Day-by-Day Blood Pressure Variability and Functional Outcome After Acute Ischemic Stroke

Fukuda

Kai

Kamouchi

et al. 2015

Stroke

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“…44 Also, in experimental studies on hypertensive rats, the restoration of BRS yielded protection against end-organ damage and against cognitive impairment. 45, 46 Thus, improvement of baroreflex function could be viewed as a potential therapeutic target not only in stroke 47 but also in situations involving risk for cerebrovascular disease.…”

Section: Discussionmentioning

confidence: 99%

“…Pharmacological interventions include β-blockers, low-dose ketanserin, clonidine, moxonidine and mecobalamin. 47 Nonpharmacological interventions include physical training 48 and direct electric stimulation of carotid baroreceptors with an implantable device. 49 …”

Section: Discussionmentioning

confidence: 99%

Baroreflex and Cerebral Autoregulation Are Inversely Correlated

Nasr

Czosnyka

Traon

et al. 2014

Circ J

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“…[1][2][3] Possible pathophysiological mechanisms include increased cardiovascular complications, arrhythmias, blood pressure (BP) derangements, nondiabetic hyperglycemia, and promotion of secondary brain injury because of local inflammation and edema. 4 Thus, the modifying of impaired autonomic functions may have important therapeutic implications in acute ischemic stroke. In animal models, β-blockers (BBs) given before the induction of experimental ischemia lead to a reduction in infarct volume by 40%.…”

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confidence: 99%

β-Blockers, Pneumonia, and Outcome After Ischemic Stroke

Sýkora

Šiarnik

Diedler

et al. 2015

Stroke

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Background and Purpose-Increased sympathetic drive after stroke is involved in the pathophysiology of several complications including poststroke immunudepression. β-Blocker (BB) therapy has been suggested to have neuroprotective properties and to decrease infectious complications after stroke. We aimed to examine the effects of random pre-and onstroke BB exposure on mortality, functional outcome, and occurrence of pneumonia after ischemic stroke. Methods-Data including standard demographic and clinical variables as well as prestroke and on-stroke antihypertensive medication, incidence of pneumonia, functional outcome defined using modified Rankin Scale and mortality at 3 months were extracted from the Virtual International Stroke Trials Archive. For statistical analysis multivariable Poisson regression was used. Results-In total, 5212 patients were analyzed. A total of 1155 (22.2%) patients were treated with BB before stroke onset and 244 (4.7%) patients were newly started with BB in the acute phase of stroke. Mortality was 17.5%, favorable outcome (defined as modified Rankin Scale, 0-2) occurred in 58.2% and pneumonia in 8.2% of patients. Prestroke BB showed no association with mortality. On-stroke BB was associated with reduced mortality (adjusted risk ratio, 0.63; 95% confidence interval, 0.42-0.96). Neither prestroke BB nor on-stroke BB showed an association with functional outcome. Both prestroke and on-stroke BB were associated with reduced frequency of pneumonia (adjusted risk ratio, 0.77; 95% confidence interval, 0.6-0.98 and risk ratio, 0.49; 95% confidence interval, 0.25-0.95). Conclusions-In this large nonrandomized comparison, on-stroke BB was associated with reduced mortality. Prestroke and on-stroke BB were inversely associated with incidence of nosocomial pneumonia. Randomized trials investigating the potential of β-blockade in acute stroke may be warranted.

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Baroreflex: A New Therapeutic Target in Human Stroke?

Cited by 98 publications

References 74 publications

Day-by-Day Blood Pressure Variability and Functional Outcome After Acute Ischemic Stroke

Day-by-Day Blood Pressure Variability and Functional Outcome After Acute Ischemic Stroke

Baroreflex and Cerebral Autoregulation Are Inversely Correlated

β-Blockers, Pneumonia, and Outcome After Ischemic Stroke

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