Blood Pressure Variability in Acute Ischemic Stroke: Influence of Infarct Location in the Insular Cortex

Abstract

Background: The aim of this study was to elucidate the influence of insular infarction on blood pressure (BP) variability and outcomes according to the region of the insular cortex affected. Methods: A total of 90 patients diagnosed with acute unilateral ischemic stroke were registered. The BP variability was calculated over 24 h after admission (hyperacute) and for 2–3 days after admission (acute). Patients were classified into groups of right and left, and then right anterior, right posterior, left anterior, and left posterior insular infarction. Results: Patients with insular infarction showed a significantly larger infarct volume, higher modified Rankin scale scores, and lower SD and coefficient of variation (CV) of ­systolic BP in the hyperacute phase than shown by patients without insular infarction (p < 0.01, p < 0.01, p = 0.02, and p = 0.03, respectively). The SD and CV of systolic BP in the hyperacute phase showed significant differences among the 3 groups with right insular infarction, with left insular infarction, and without insular infarction (p < 0.05 and p < 0.05, respectively). There was a tendency for the systolic BP variability to be lower in patients with right anterior insular infarction than in patients with infarcts in other areas. Conclusion: The right insular cortex, especially the anterior part, might be a hub for autonomic nervous regulation.

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

“…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 .…”

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

“…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 .…”

Blood pressure characteristics in patients with acute basilar artery occlusion undergoing endovascular thrombectomy

“…Brain territories responsible for BP variability have been investigated in several studies, and recently Kitamura et al . showed that BP variability in the hyperacute phase tended to be low in patients with right insular infarction and high in those with left insular infarction 28 . However, this effect persisted only in the hyperacute phase for the first 24 hours after admission.…”