Nocturnal blood pressure dipping in acute ischemic stroke

Sargento-Freitas, João; Laranjinha, Inês; Galego, Orlando; Ferreira, Arlindo R.; Moura, Bernardo Melo; Correia, Manuel; Silva, Fernando; Machado, Carlos; Cordeiro, Gustavo; Cunha, Luı́s

doi:10.1111/ane.12402

Cited by 15 publications

(8 citation statements)

References 23 publications

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“…This acute hypertensive response has many possible causes: pain, stress, and dehydration related to the pathological situation, ischemia in strategic brain locations, elevated serum catecholamine levels arising from ischemic areas, and impaired baroreceptor sensitivity. 14,15 BP values tend to return to prestroke levels within 10 days. 16 Early recanalization has been described as one of the most important predictors of good clinical outcome.…”

Section: Discussionmentioning

confidence: 96%

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Recanalization Modulates Association Between Blood Pressure and Functional Outcome in Acute Ischemic Stroke

Martins

Sargento-Freitas

Silva

et al. 2016

Stroke

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Classically, the relationship between systolic BP (SBP) and clinical outcome was described as U-or J shaped, with both high and low values of BP being independent prognostic factors for poor outcome.2,3 Nonetheless, these studies did not consider the recanalization state of the affected arterial territory, which may directly influence the hemodynamic response.The main objective of this study is to determine the relationship between BP during the first 24 hours after ischemic stroke and clinical outcome in patients submitted to intravenous or intra-arterial recanalization treatments. Methods Study PopulationWe included consecutive patients with acute ischemic stroke from July 2009 to June 2015, treated with intravenous thrombolysis (IVrtPA) or intra-arterial therapies in our tertiary, university hospital in Portugal. The exclusion criteria were as follows: patients who had insufficient BP data (ie, incomplete BP readings in the first 24 hours poststroke due to patient death or early hospital transfer); unavailable information Background and Purpose-Historical stroke cohorts reported a U-or J-shaped relationship between blood pressure (BP) and clinical outcome. However, these studies predated current revascularization strategies, disregarding the recanalization state of the affected arterial territory. We aimed to investigate the relationship between BP in the first 24 hours after ischemic stroke and clinical outcome in patients submitted to intravenous or intra-arterial recanalization treatments. Methods-Consecutive patients with acute stroke treated with intravenous thrombolysis or intra-arterial therapies were enrolled in a retrospective cohort study. BP was measured on regular intervals throughout day and night during the first 24 hours after stroke onset. The mean systolic BP and diastolic BP during the first 24 hours post stroke were calculated.Recanalization was assessed at 6 hours by transcranial color-coded Doppler, angiography, or angio-computed tomography.Functional outcome was assessed at 3 months by modified Rankin Scale. Linear and quadratic multivariate regression models were performed to determine associations between BP and functional outcome for the whole population and recanalyzed and nonrecanalyzed patients. Results-We Conclusions-Systemic

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Section: Discussionmentioning

confidence: 96%

“…15 For our study, we chose to analyze the mean 24-hour BP to increase validity and applicability. It is also likely that any major night time fluctuation would be reflected in the mean 24-hour BP, thus reducing a possible confounding effect.…”

Section: Discussionmentioning

confidence: 99%

Recanalization Modulates Association Between Blood Pressure and Functional Outcome in Acute Ischemic Stroke

Martins

Sargento-Freitas

Silva

et al. 2016

Stroke

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“…When invasive monitoring is contraindicated or unavailable, an accurate non‐invasive method would be desirable. Moreover, there are many ‘borderline’ situations in which the insertion of an invasive monitoring is questioned, but a non‐invasive ICP measurement could be useful , in particular in children .…”

Section: Discussionmentioning

confidence: 99%

Non-invasive assessment of intracranial pressure

et al. 2015

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Monitoring of intracranial pressure (ICP) is invaluable in the management of neurosurgical and neurological critically ill patients. Invasive measurement of ventricular or parenchymal pressure is considered the gold standard for accurate measurement of ICP but is not always possible due to certain risks. Therefore, the availability of accurate methods to non-invasively estimate ICP has the potential to improve the management of these vulnerable patients. This review provides a comparative description of different methods for non-invasive ICP measurement. Current methods are based on changes associated with increased ICP, both morphological (assessed with magnetic resonance, computed tomography, ultrasound, and fundoscopy) and physiological (assessed with transcranial and ophthalmic Doppler, tympanometry, near-infrared spectroscopy, electroencephalography, visual-evoked potentials, and otoacoustic emissions assessment). At present, none of the non-invasive techniques alone seem suitable as a substitute for invasive monitoring. However, following the present analysis and considerations upon each technique, we propose a possible flowchart based on the combination of non-invasive techniques including those characterizing morphologic changes (e.g., repetitive US measurements of ONSD) and those characterizing physiological changes (e.g., continuous TCD). Such an integrated approach, which still needs to be validated in clinical practice, could aid in deciding whether to place an invasive monitor, or how to titrate therapy when invasive ICP measurement is contraindicated or unavailable.

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“…We classified circadian BPV patterns as dippers (≥10 to < 20%), non-dippers (≥0 to < 10%), reverse dippers (< 0%), and extreme dippers (≥20%) according to the percentage difference between mean daytime and nocturnal BP [12,13]. We dichotomized these patterns into nighttime risers (reverse dippers) and others.…”

Section: Methodsmentioning

confidence: 99%

The Relationship between Blood Pressure Variability, Recanalization Degree, and Clinical Outcome in Large Vessel Occlusive Stroke after an Intra-Arterial Thrombectomy

et al. 2018

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Background: Blood pressure variability (BPV) is associated with target organ damage progression and increased cardiovascular events, including stroke. The aim of this study was to evaluate the associations between short-term BPV during acute periods and recanalization degree, early neurological deterioration (END) occurrence, and functional outcomes in acute ischemic stroke patients who had undergone intra-arterial thrombectomy (IAT). Methods: We retrospectively analyzed 303 patients with large vessel occlusive stroke who underwent IAT. The following BPV parameters, measured over 24 and 48 h after IAT, were compared: the mean, SD, coefficient of variation (CV), variation independent of the mean (VIM) for both the systolic BP (SBP) and diastolic BP, and the proportion of nocturnal SBP risers. Results: BPV parameters decreased with higher recanalization degree. The mean SBP (SBP_mean) over 24 and 48 h after IAT, and the SD of SBP (SBP_SD), CV of SBP (SBP_CV), and VIM of SBP (SBP_VIM) during the 48 h following the procedure had significant associations with recanalization degree. Patients with END had higher BPV than that of those without END, and the difference was more evident for incomplete recanalization. Increased BPV was associated with a shift toward poor functional outcome at 3 months after adjustment, including recanalization degree (OR range for significant parameters, 1.26–1.64, p = 0.006 for 48 h SBP_mean, p = 0.003 for 48 h SBP_CV, otherwise p < 0.002). Conclusions: Short-term BPV over 24 and 48 h after IAT in acute ischemic stroke patients was related to recanalization degree, and END occurrence, and may be an independent predictor of clinical outcome.

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Nocturnal blood pressure dipping in acute ischemic stroke

Cited by 15 publications

References 23 publications

Recanalization Modulates Association Between Blood Pressure and Functional Outcome in Acute Ischemic Stroke

Recanalization Modulates Association Between Blood Pressure and Functional Outcome in Acute Ischemic Stroke

Non-invasive assessment of intracranial pressure

The Relationship between Blood Pressure Variability, Recanalization Degree, and Clinical Outcome in Large Vessel Occlusive Stroke after an Intra-Arterial Thrombectomy

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