Blood pressure variability and prognosis in acute ischemic stroke with vascular compression on the rostral ventrolateral medulla (RVLM)

Aoki, Shiro; Ohtsuki, Toshiho; Hosomi, Naohisa; Sueda, Yoshimasa; Kono, Tomoyuki; Yamawaki, Takemori; Matsumoto, Masayasu

doi:10.1038/hr.2011.17

Cited by 15 publications

(8 citation statements)

References 28 publications

(33 reference statements)

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“…ambient temperature, atmospheric pressure, and sunlight. Serial changes in physical conditions affect health conditions [18, 19], such as blood pressure and blood glucose fluctuations, which adversely affect stroke patient outcomes [20, 21]. Our results consistently demonstrate that the frequencies of ischemic stroke and intracerebral hemorrhage exhibit high risk ratio when temperature become cooler in 4 days prior to the onset.…”

Section: Discussionsupporting

confidence: 66%

Various meteorological conditions exhibit both immediate and delayed influences on the risk of stroke events: The HEWS–stroke study

et al. 2017

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We hypothesized that meteorological conditions on the onset day and conditions on the former days may play important roles in the modulation of physical conditions. Associations of meteorological factors and their changes in former days with stroke onset are of interest. We conducted a multicenter retrospective study to evaluate the frequency of stroke events and their interaction with meteorological conditions and their daily changes. Acute stroke patients (n = 3935, 73.5±12.4 years, 1610 females) who were admitted to 7 stroke hospitals in three restricted areas were enrolled in this study. Poisson regression models involving time-lag variables was used to compare daily rates of stroke events with mean thermo-hydrological index (THI), atmospheric pressure, and their daily changes. We divided onset days into quintiles based on the THI, atmospheric pressure, and their daily changes for the last 7 days. The frequencies of ischemic stroke significantly increased when THI varied either cooler or warmer from a previous day (extremely cooler, risk ratio (RR) 1.19, 95% confidence interval (CI) 1.05 to 1.34; extremely warmer, RR 1.16, 95% CI 1.03 to 1.31; r2 = 0.001 for the best regression, p = 0.001). Intracerebral hemorrhage frequencies significantly decreased on high-THI days (extremely high, RR 0.72, 95% CI 0.54 to 0.95; r2 = 0.013 for the best regression, p<0.001) and increased in high atmospheric pressure days (high, RR 1.31, 95% CI 1.04 to 1.65; r2 = 0.009 for the best regression, p<0.001). Additionally, even after adjusting for the THI on the onset day and its changes for the other days, intracerebral hemorrhage increased when THI got extremely cooler in 4 days prior (RR 1.33, 95% CI 1.03 to 1.71, r2 = 0.006 for the best regression, p<0.001). Various meteorological conditions may exhibit influences on stroke onset. And, when temperature cooled, there may be a possibility to show delayed influence on the frequency of intracerebral hemorrhage 4 days later.

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Section: Discussionsupporting

confidence: 66%

Various meteorological conditions exhibit both immediate and delayed influences on the risk of stroke events: The HEWS–stroke study

et al. 2017

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“…Vascular compression on the rostral ventrolateral medulla and insular infarction are often discussed as components of the central nervous system that influence autonomic dysfunction. As shown in our previous study, these factors are associated with BP variability in patients with AIS . In addition, increased short‐term BP variability is associated with autonomic nervous dysfunction, such as an enhanced sympathetic drive and an impaired baroreflex function .…”

Section: Discussionsupporting

confidence: 61%

Increased blood pressure variability during the subacute phase in patients with ischemic stroke presenting with a low ankle‐brachial index

Naito

Hosomi

Kuzume

et al. 2020

Geriatrics Gerontology Int

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Aim: This study aimed to evaluate the associations of blood pressure (BP) variability in patients with ischemic stroke during the subacute phase using ambulatory blood pressure monitoring and the ankle-brachial index (ABI). Methods:We retrospectively examined 831 consecutive patients (women 44.8%, mean age 76 AE 12 years) with acute ischemic stroke who underwent 24-h ambulatory blood pressure monitoring during the subacute phase of stroke (median 9 days from onset) and an ABI examination. BP variability was evaluated by assessing the standard deviation and coefficient of variation of systolic BP and diastolic BP. A low ABI was defined as an ABI <0.9.Results: Of the 831 patients, 201 (24.2%) had a low ABI. Older age, lower body mass index, diabetes mellitus, chronic kidney disease, atrial fibrillation and a higher National Institutes of Health Stroke Scale score at admission were independently associated with a low ABI. The patients with a low ABI had a higher mean 24-h diastolic BP, higher standard deviation of both BP measurements (systolic BP and diastolic BP) and a higher coefficient of variation in both BP measurements than those with a higher ABI. According to the multivariable linear regression analysis, a low ABI was independently associated with increased BP variability (a high standard deviation or coefficient of variation of both BP measurements) after adjusting for baseline confounders. Conclusions:A low ABI was associated with increased BP variability during the subacute ischemic phase. Geriatr Gerontol Int 2020; 20: 448-454.

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“…The association between BP variability during the acute stage of ischemic stroke and outcomes has been investigated recently, but the relationship remains unclear. Various factors, such as brain edema, hemorrhagic www.nature.com/scientificreports www.nature.com/scientificreports/ transformation, vessel recanalization, increased sympathetic drive, and mental stress at admission, affect acute-phase BP levels [17][18][19][20] . In addition, reactive hypertension occurs after the onset of stroke, and elevated BP levels fall remarkably during the first 7 days of onset, with little change thereafter 21 .…”

Section: Discussionmentioning

confidence: 99%

Increased blood pressure variability during the subacute phase of ischemic stroke is associated with poor functional outcomes at 3 months

Naito

Hosomi

Kuzume

et al. 2020

Sci Rep

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thus far, it is well known that increased blood pressure variability may exacerbate stroke outcomes. Blood pressure in the acute phase would be influenced by both reactive hypertension to stroke and intrinsic blood pressure reactivity. thus, we aimed to evaluate the association between blood pressure variability and outcomes at 3 months using ambulatory blood pressure monitoring in ischemic stroke patients in the subacute phase after reactive hypertension subsided. We retrospectively examined 626 consecutive patients with acute ischemic stroke who underwent 24-hour ambulatory blood pressure monitoring during the subacute phase of stroke (median, 9 days from onset). The variability in blood pressure was evaluated by assessing the standard deviation and coefficient of variation of systolic and diastolic blood pressure. The primary outcome was functional status at 3 months. A poor outcome was defined as a modified Rankin scale score of 3 or more and a good outcome as 2 or less. We assessed the functional outcome at 3 months in 497 patients (79.4%). The mean systolic and diastolic blood pressure levels were not associated with functional outcome. the multivariable analysis revealed that increases in the standard deviations of systolic and diastolic blood pressure, coefficient of variation of diastolic blood pressure, and morning blood pressure surge were associated with poor outcome. Blood pressure variability during the subacute phase of ischemic stroke can be a useful prognostic indicator of poor functional outcome at 3 months in patients with acute ischemic stroke.

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Blood pressure variability and prognosis in acute ischemic stroke with vascular compression on the rostral ventrolateral medulla (RVLM)

Cited by 15 publications

References 28 publications

Various meteorological conditions exhibit both immediate and delayed influences on the risk of stroke events: The HEWS–stroke study

Various meteorological conditions exhibit both immediate and delayed influences on the risk of stroke events: The HEWS–stroke study

Increased blood pressure variability during the subacute phase in patients with ischemic stroke presenting with a low ankle‐brachial index

Increased blood pressure variability during the subacute phase of ischemic stroke is associated with poor functional outcomes at 3 months

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