Circadian blood pressure and heart rate characteristics in haemorrhagic vs ischaemic stroke in Chinese people

Abstract

To compare the circadian variation of blood pressure (BP) between patients with intra-cerebral haemorrhage (ICH) and with cerebral infarction (CI), around-the-clock BP measurements were obtained from 89 hypertensive patients with ICH, from 63 patients with CI and from 16 normotensive volunteers. The single and populationmean cosinor yielded individual and group estimates of the MESOR (Midline Estimating Statistic Of Rhythm, a rhythm-adjusted mean value), circadian double amplitude and acrophase (measures of extent and timing of predictable daily change). Comparison shows that without any difference in BP MESOR, the circadian amplitude of systolic (S) BP was larger in ICH than CI patients (Po0.001), and both groups differed from the healthy volunteers in BP MESOR and pulse pressure (Po0.001) and in the circadian amplitude of SBP (Po0.005). The smaller population circadian amplitude of diastolic (D) BP of the ICH group (P ¼ 0.042) is likely related to a larger scatter of individual circadian acrophases in this group as compared with that in the other two groups, an inference supported by a smaller day-night ratio of DBP for ICH vs CI patients (P ¼ 0.007). Heart rate (HR) variability, gauged by the standard deviation (SD), was decreased in both patient groups as compared with that in healthy controls, more so among ICH than CI patients (P ¼ 0.025). Thus, patients with ICH had a higher incidence of abnormal circadian characteristics of BP than patients with CI, the major differences relating to a larger circadian amplitude of SBP, a smaller HR-SD, and a larger incidence of odd circadian acrophases of DBP.

Nutrition in Chronocardiology: We are Indebted Professor Franz Halberg

“…lacunar, thrombotic, embolic stroke. Circadian and circaseptan variations in the onset in stroke incidence have been reported by Halberg group in relation to circadian hyperamplitude tension [91,92]. In acute myocardial ischemia, the time of onset is easily determined [93,94] corresponding with the onset of thoracic pain and does not occur when the patient with ischemic stroke is discovered on awakening; the onset may have occurred at any time during sleep.…”

“…It is possible that eating dinner rich in protective nutrients that can modulate vascular biology and increase blood pressure may be protective in the morning against stroke. There is evidence that CHAT carries several fold greater risk of stroke than MESOR hypertension [91,92]. A recent study showed that increased intake of alphalinolenic acid by eating 50-10g/day of walnuts can inhibit CHAT and decrease blood pressures.…”

The impact of heart rate circadian rhythm on in-hospital mortality in patients with stroke and critically ill: Insights from the eICU Collaborative Research Database

“…Animal studies have shown a rapid increase in mean heart rate in post-malignant stroke mice, with an increase of about 100 bpm from pre-malignant stroke [27]. Mean heart rate was signi cantly higher in patients with stroke than in those with normotensive, and heart rate variability was greater in patients with ischemic stroke than in patients with hemorrhagic stroke [29]. At present, no evidence has been found to explain the increase in mortality with increased Amplitude of heart rate in stroke and critically ill patients, which requires further investigation.…”