A stress-related explanation to the increased blood pressure and its course following ischemic stroke

Abstract

BackgroundA hypertensive response after ischemic stroke is frequent, yet its pathophysiology is unknown. Mechanisms related to local ischemic damage, major vascular occlusion, and psychological stress due to acute illness have been proposed. We assessed the natural course of blood pressure (BP) within the first 24 h in groups of ischemic stroke patients with different characteristics. We hypothesized that a consistent BP reduction, regardless of stroke location, time window from debut to admission and presence of persistent vascular occlusion, would favor a stress-related mechanism as an important cause of the hypertensive response after ischemic stroke.MethodsIschemic stroke patients (n=1067) were prospectively registered, and BP was measured on admission and <3 h, 3–6 h, 6–12 h and 12–24 h after admission. Patients were categorized according to the location of diffusion-weighted imaging (DWI) lesions (cortical, large subcortical, mixed cortico-subcortical, lacunar, cerebellar, brain stem or multiple), time window (admitted within or after 6 h of symptom onset) and presence of persistent proximal middle cerebral artery (MCA) occlusion versus normal findings on magnetic resonance angiography (MRA) at 24 h.ResultsA reduction in systolic BP and diastolic BP from baseline to 12–24 h was found across all DWI locations except for diastolic BP in cerebellar (P=0.072) lesions. Apart from diastolic BP in patients with normal MRA findings at 24 h (P=0.060), a significant fall in systolic BP and diastolic BP at 12–24 h was registered, irrespective of whether patients were admitted within 6 h or after 6 h of stroke onset or had persistent MCA occlusion versus normal MRA findings.ConclusionWe found a relatively consistent decline in BP within 24 h after admission across different stroke locations in patients admitted within or after 6 h of stroke onset and in patients with persistent MCA occlusion. Our findings suggest that a systemic factor such as psychological stress may be an important contributor to the frequently elevated BP on admission in patients with ischemic stroke.

A Score for Risk of Thrombolysis-Associated Hemorrhage Including Pretreatment with Statins

“…Risk factors for sICH after thrombolysis such as stroke severity, onset-to-treatment time, and early signs of infarction on CT may reflect the extent and progression of ischemic injury to the blood–brain barrier. Other risk factors such as stroke-associated hyperglycemia and hypertension may represent an acute stroke-related stress reaction ( 24 , 25 ), and there is debate whether stroke-associated hyperglycemia is merely an epiphenomenon (and a marker) or a cause of poor outcome and sICH ( 22 , 26 ). In contrast to these risk factors, the novel candidate risk factor pretreatment with statins may contribute to a higher risk of clinically relevant hemorrhage after rt-PA via different mechanisms.…”

The effects of diffusion and perfusion MRI mismatch on the admission blood glucose and blood pressure values measured in the first 12 hours of acute stroke

“…Because thrombotic or embolic occlusion is the reason for acute ischemic stroke, it might be the first trigger point leading to high blood pressure. Kvistad et al [15] found that, independent from the stroke subtype and proximal vessel occlusion, hypertensive patients (n = 1067) who were admitted with the complaint of acute stroke within the first 6 hours or later showed a significant decrease in blood pressure in the 24th hour after their admission. The reason for this finding might be because of psychological stress or white coat hypertension.…”

“…In the present study, no relationship was found between high admission blood pressure and proximal vessel occlusion, which is consistent with Kvistad et al's study. [15]…”

Relation between left atrial structure and lacunar infarction in patients with hypertension

“…Lacunar infarct (LACI), a small deep infarct that results from occlusion of a penetrating artery, accounts for approximately one-quarter of all ischemic strokes [ 1 ]. The corresponding lesion in the brain issue is removed to ultimately form a small cavity with a diameter of no more than 20 mm, although the majority of which are 2 to 4 mm.…”