Changes of circadian blood pressure patterns after hemodynamic and thromboembolic brain infarction.

Abstract

Background and PurposeWe investigated the changes of circadian blood pressure patterns after thromboembolic and hemodynamic brain infarction and evaluated the relation between circadian blood pressure variation, infarct location, and activation of the autonomic nervous system after thromboembolic stroke.Methods Repeated 24-hour blood pressure measurements were performed in 45 patients with proven first-ever brain infarctions of different origins. Evaluation of serum norepinephrine concentration, prolongation of the QT interval, and degree of cardiac arrhythmias were used to determine the extent of sympathetic activation after thromboembolic stroke.Results Whereas circadian blood pressure variation was significantly increased after hemodynamic infarction compared with a control group (diastolic, -752±A5% versus -13.8±6.5%; P<.005), a clearly reduced variation was observed after thromboembolic infarction (diastolic, -5.2±6.9%). Blood pressure variation was positively related to serum norepinephrine concen-

Stroke‐induced chronic systolic dysfunction driven by sympathetic overactivity

“…Because a right insular stroke is associated with an acute and prolonged sympathetic stimulation,9, 30, 31 we next evaluated the impact of the autonomic nervous system on the development of chronic cardiac dysfunction after right hemispheric tMCAO. For this purpose, we analyzed the brain tissue mRNA levels of TH, which is the rate‐limiting enzyme in catecholamine synthesis.…”

N-Acetylaspartate/Creatine and Choline/Creatine Ratios in the Thalami, Insular Cortex and White Matter as Markers of Hypertension and Cognitive Impairment in the Elderly

“…Since the insular cortex mediates arterial blood pressure (11)(12)(13), it is legitimate to ask whether metabolic disorders in the insula of hypertensives are a cause or a consequence of the hypertension. Unfortunately, the cross-sectional study design and the antihypertensive drugs taken by members of the cohort prevent us from formulating a direct response to this question.…”

“…In addition, the insular cortex, a key site of limbic autonomic integration that is also involved in the circadian blood pressure regulation (11)(12)(13), was included in the analysis.…”

Prognostic value of blood pressure in acute stroke

“…[13][14][15][16][17][18]27,28 A differential effect might also exist in relation to stroke outcome. Moreover, instead of analysing a single measurement such as the first one post-stroke, using several BP measurements may more reliably reflect any impact of BP level on brain tissue damage or salvage.…”

“…Earlier studies reported that patients with a blunted fall in nocturnal BP are more likely to suffer hypertensive target-organ damage, which would mean that BP during sleep is more closely related to target-organ damage than BP in the awake state. [13][14][15][16][17] Therefore, in the present study, we analysed various BP characteristics (including daytime and night-time BP values) as independent predictors of outcome at 3 months in patients admitted to a stroke unit within 24 h following stroke onset. We also explored whether a drop in BP values during the first 4 days was related to outcome.…”