Blood Pressure Surge Precedes Intracerebral Hemorrhage

Leira, Enrique C.; Acharya, Aninda B.; Cruz‐Flores, Salvador; Albaker, Osamah; Rao, Venkat K.; Abdulrauf, Saleem I.

doi:10.1385/ncc:2:1:043

Cited by 4 publications

(3 citation statements)

References 14 publications

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“…Several investigators have proposed that an exaggerated morning BP surge may advance vascular remodeling from the larger arteries to the small resistance vessel because of the shear stress of an exaggerated fluctuations of blood flow on the vessel wall. [22][23][24] Indeed, various cardiovascular morbidities have been described in patients with an exaggerated morning BP surge. These studies, conducted primarily in adults, consistently indicate that morning BP surge is an important predictor of the development of risk markers such as increased carotid intima thickness 14 myocardial hypertrophy and infarction 25 and cardiovascular events, such as stroke.…”

Section: Discussionmentioning

confidence: 99%

Activity-Adjusted 24-Hour Ambulatory Blood Pressure and Cardiac Remodeling in Children with Sleep Disordered Breathing

et al. 2008

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Abstract-Questions remain as to whether pediatric sleep disordered breathing increases the risk for elevated blood pressure and blood pressure-dependent cardiac remodeling. We tested the hypothesis that activity-adjusted morning blood pressure surge, blood pressure load, and diurnal and nocturnal blood pressure are significantly higher in children with sleep disordered breathing than in healthy controls and that these blood pressure parameters relate to left ventricular remodeling. 24-hour ambulatory blood pressure parameters were compared between groups. The associations between blood pressure and left ventricular relative wall thickness and mass were measured. 140 children met the inclusion criteria. In children with apnea hypopnea index Ͻ5 per hour, a significant difference from controls was the morning blood surge. Significant increases in blood pressure surge, blood pressure load, and in 24-hour ambulatory blood pressure were evident in those whom the apnea hypopnea index exceeded 5 per hour. Sleep disordered breathing and body mass index had similar effect on blood pressure parameters except for nocturnal diastolic blood pressure, where sleep disordered breathing had a significantly greater effect than body mass index. Diurnal and nocturnal systolic blood pressure, diastolic blood pressure, and mean arterial blood pressure predicted the changes in left ventricular relative wall thickness. Therefore, sleep disordered breathing in children who are otherwise healthy is independently associated with an increase in morning blood pressure surge, blood pressure load, and 24-hour ambulatory blood pressure. The association between left ventricular remodeling and 24-hour blood pressure highlights the role of sleep disordered breathing in increasing cardiovascular morbidity. Key Words: sleep apnea Ⅲ children Ⅲ ambulatory blood pressure Ⅲ blood pressure surge Ⅲ blood pressure load Ⅲ cardiac remodeling Ⅲ hypertrophy T he association between sleep disordered breathing (SDB) and cardiovascular morbidity in adults has become an important consideration in the management of patients with SDB. Results from numerous cross-sectional and prospective studies of blood pressure (BP) control in adults support the concept that hypertension is an intermediate end point between SDB and cardiovascular disease. 1,2 Further support of this concept is derived from studies linking SDB to atherosclerotic pathways. [3][4][5][6] These studies provide insight into the mechanisms of vascular injury secondary to SDB. Although the impact of duration of this disorder on the development of risk factors for cardiovascular disease is difficult to estimate, morbidity secondary to SDB seems to manifest gradually, often taking decades. As such, with the exception of isolated cases of heart failure, children with SDB rarely show evidence of cardiovascular disease. Thus far, studies addressing whether children with SDB acquire risk factors for the early development of cardiovascular disease are inconclusive.Findings from several pediatric studies suggest ...

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Section: Discussionmentioning

confidence: 99%

Activity-Adjusted 24-Hour Ambulatory Blood Pressure and Cardiac Remodeling in Children with Sleep Disordered Breathing

et al. 2008

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“…Although acute BP elevations were suggested as contributing to the cause of the ICHs in these cases, BP monitoring prior to and at the onset of the ICH was unavailable. Leira et al have reported the case of a neurologically intact 64-year-old female who was monitored in an ICU for respiratory distress and subsequently became altered, exhibiting a right hemispheric syndrome 3.5 h after developing SBP in the 200 mmHg range [10]. An unenhanced CT of the brain subsequently demonstrated a right ICH.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Intracerebral Hemorrhage Following a Blood Pressure Surge During Emergency Department Evaluation

Levis¹,

Kiang²,

Flint

2010

Neurocrit Care

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“…We itere Risikofaktoren für eine primäre ICB sind einerhöhtesLebensalter(mit einer Ve rdopplung desR isikos etwa alle 10 Jahre), männlichesG eschlecht ( Unabhängige Faktoren in derAkutphase derICB,die sich ungünstigauf denVerlauf auswirken,s ind eine erhöhte Körpertemperatur von>3 7,5°C, eine Erhöhung des Blutglukosespiegels, eine rhöhterF ibrin-spiegelimSerum von>523 mg/dl sowieein noch nach 48 Stundene rhöhterB lutdruck (33,34,47).…”

Section: äTiologieund Risikofaktorenunclassified

Hämostatische Therapie der intrazerebralen Blutung

Jüttler¹,

Steiner²

2007

Nervenheilkunde

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ZusammenfassungIn den letzten Jahren rückte die spontane intrazerebrale Blutung (ICB) mehr und mehr in das Interesse der Schlaganfallforschung und ist dabei, neben der zerebralen Ischämie, einen zweiten Schwerpunkt klinischer Studien zu bilden. Entscheidend hierfür waren unter anderem zwei multizentrische, randomisierte, kontrollierte Therapiestudien, die Anfang 2005 veröffentlicht wurden: Die International Surgical Trial in Intracerebral Haemorrhage (STICH) und die Studie über den rekombinanten aktivierten Faktor VII. Beide beruhen auf der pathophysiologischen Überlegung einer Verbesserung des klinischen Verlaufs durch Verkleinerung des intrazerebralen Hämatoms, entweder durch chirurgische Entfernung oder durch medikamentöse Verminderung des Hämatomwachstums. Wir fassen die wesentlichen ätiologischen und pathophysiologischen Hintergründe der hämostatischen Therapie der ICB zusammen und gehen kurz auf die Antikoagulantien (OAT)-assoziierte ICB ein. Zum Schluss diskutieren wir die Konsequenzen für die zukünftige Therapie und für weitere klinische Studien.

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Blood Pressure Surge Precedes Intracerebral Hemorrhage

Abstract: In this monitored case, the BP surge clearly preceded the onset of neurological symptoms by 3.5 hours, supporting the view that the acute BP elevation was the cause of ICH.

Cited by 4 publications

References 14 publications

Activity-Adjusted 24-Hour Ambulatory Blood Pressure and Cardiac Remodeling in Children with Sleep Disordered Breathing

Activity-Adjusted 24-Hour Ambulatory Blood Pressure and Cardiac Remodeling in Children with Sleep Disordered Breathing

Spontaneous Intracerebral Hemorrhage Following a Blood Pressure Surge During Emergency Department Evaluation

Hämostatische Therapie der intrazerebralen Blutung

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