Salivary Cortisol, a Biological Marker of Stress, Is Positively Associated with 24-Hour Systolic Blood Pressure in Patients with Acute Ischaemic Stroke

Abstract

Background/Aim: The cause of elevated blood pressure (BP) in acute stroke is unknown. Stress is often suggested as a main contributing factor. We aimed to investigate the relationship between BP and stress in patients with acute stroke. Methods: 58 patients with clinical symptoms of stroke were recruited prospectively after exclusion of haemorrhage by CT scan within 14 h and 15 min (mean) after symptom onset (range 2 h and 45 min–23 h and 40 min). The mean age of the patients was 66 years (range 39–86 years), and the mean National Institute of Health Stroke Scale score was 7 (range 1–26). BP and pulse rate were recorded by non-invasive automatic monitoring hourly for 24 h. Stress was evaluated by testing the level of salivary cortisol. Four samples of saliva were obtained at inclusion, on the evening of the inclusion day (20.00–22.00 h), on the morning of the next day (7.00–9.00 h) and on the afternoon of the inclusion day/next day (15.00–17.00 h) within 24 h after inclusion in the study. Logarithmic transformation was done for cortisol levels. Results: The 24-hour mean cortisol level (geometric mean 13.6 nmol/l) was related to 24-hour mean systolic BP [SBP; r = 0.36, p = 0.01, multivariate p = 0.02], mean night-time (22.00–6.00 h) SBP (r = 0.43, p = 0.001, multivariate p < 0.005) and mean night-time diastolic BP (r = 0.31, p = 0.02, multivariate p = 0.02). Cortisol levels at inclusion (r = 0.31, p = 0.02, multivariate p = 0.05 for 24-hour SBP) and in the evening were also statistically significantly related to the above BP variables. The morning cortisol (r = 0.28, p = 0.04, multivariate p = 0.04) was related to night-time SBP. Conclusions: Salivary cortisol was positively correlated with 24-hour SBP and night-time BP, suggesting that stress is a contributing factor for high BP in acute stroke.

Response of Salivary Stress Markers in Conscious and Unconscious Patients with Acute Ischemic Stroke

“…As such, the findings indicate that salivary amylase can be useful as a novel diagnostic biomarker for AMI 21) . Ahmed et al 22) conducted a study on 58 adult ischemic stroke patients within 24 hours of onset, monitoring BP and salivary cortisol for 24 hours. A positive correlation was observed between salivary cortisol and 24-hour mean systolic BP, as well as nighttime BP, indicating that stress and elevated BP are associated 22) .…”

“…Ahmed et al 22) conducted a study on 58 adult ischemic stroke patients within 24 hours of onset, monitoring BP and salivary cortisol for 24 hours. A positive correlation was observed between salivary cortisol and 24-hour mean systolic BP, as well as nighttime BP, indicating that stress and elevated BP are associated 22) . The present study showed increased salivary cortisol in ischemic stroke patients, as was seen in the Ahmed study, but did not indicate any correlation with severity or infarct volume.…”

The Time Course and Determinants of Blood Pressure within the First 48 h after Ischemic Stroke

“…Poststroke high blood pressure has been related to both urinary catecholamines [10] and salivary cortisol [11], suggesting that a neuroendocrine stress response explains the poststroke blood pressure changes. The processes leading to activation of this response are not clear, and may include psychological stress including a white-coat effect as suggested by Christensen et al [7].…”

Temporal control of glucocorticoid neurodynamics and its relevance for brain homeostasis, neuropathology and glucocorticoid-based therapeutics

“…This is also the case in neurological conditions. Association of GCs with stroke evolution and prognosis has for instance been highlighted in clinical terms, since cortisol levels were found high during the first post-stroke week and such concentrations were associated with higher prevalence of systolic blood hypertension and night-time blood hypertension 24-hours after stroke (Ahmed et al, 2004), and with increased dependency, delirium incidences, depression and mortality rates in post-stroke patients (though these conclusions are not necessarily independent of stroke severity and thus GC levels cannot be used as independent prognostic markers) (Barugh et al, 2014).…”