Total Atherosclerosis Burden of Baroreceptor-Resident Arteries Independently Predicts Blood Pressure Dipping in Patients With Ischemic Stroke

Kong, Qi; Ma, Xiaoli; Wang, Chen; Du, Xin; Ren, Yi; Wan, Yungao

doi:10.1161/hypertensionaha.120.15036

Cited by 18 publications

(27 citation statements)

References 28 publications

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“…Also, patients in whom nocturnal non-dipping was evident and who had SVD on MRI, were more likely to have a severe stroke. Whereas our research does not have prolonged follow-up, other studies have shown that patients with nocturnal non-dipping patterns are at a higher risk of stroke and CAD ( 2 – 5 ). Finally, nocturnal non-dipping of the heart rate was also associated with significantly higher rates of silent strokes and SVD.…”

Section: Discussionmentioning

confidence: 64%

“…Common disorders associated with non-dipping include diabetes mellitus, obstructive sleep apnea, chronic renal failure, and secondary causes of hypertension (2)(3)(4). A recent report suggested that atherosclerosis-related dysfunction in the baroreceptor may be related to poor nocturnal dipping in patients with stroke (5). The "non-dipping" and "reverse dipping" patterns may result in a higher 24-h mean blood pressure level leading to greater pressure load and shear stress on vessels resulting in accelerated atherosclerosis (4,6).…”

Section: Introductionmentioning

confidence: 99%

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Night-Time Non-dipping Blood Pressure and Heart Rate: An Association With the Risk of Silent Small Vessel Disease in Patients Presenting With Acute Ischemic Stroke

et al. 2021

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Background and Purpose: Nocturnal non-dipping blood pressure and heart rate are associated with an increased risk of cardiovascular disease. The effects of such variance on cerebrovascular disease have not been well studied.Methods: The 24-h ambulatory blood pressure (ABPM) and heart rate were monitored with B-pro in patients with acute stroke within the initial week of hospital admission. The risk factor profiles, clinical presentation, imaging, and short-term prognosis were compared in nocturnal dippers and non-dippers (more than 10% nocturnal decrease) of blood pressure and heart rate.Results: We enrolled 234 patients in whom ABPM and MRI data were available. Heart rate data were available in 180 patients. Lacunar sub-cortical stroke was the most common acute lesion (58.9%), while hypertension (74%) and diabetes (41.5%) were the most common associated risk factors. ABPM revealed non-dipping in 69% of patients. On univariate analysis, Small Vessel Disease (SVD) was significantly more frequent in non-dippers vs. dippers (BP: 56.8 vs. 40.3% p = 0.02; heart rate: 57.9 vs. 40.7% p = 0.03). Silent strokes were also more frequent in non-dippers vs. dippers (BP: 40.7 vs. 26.4% p = 0.35; heart rate: 44.6 vs. 25.4% p = 0.01). Multivariate analysis revealed SVD to be significantly related to age, hypertension, blood pressure non-dipping, and severity of symptoms at index event.Conclusions: The presence of nocturnal non-dipping of blood pressure and heart rate are associated with an increased risk of silent stroke and SVD. Increased use of ABPM may allow for improved diagnosis of non-dippers.

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Section: Discussionmentioning

confidence: 64%

Section: Introductionmentioning

confidence: 99%

Night-Time Non-dipping Blood Pressure and Heart Rate: An Association With the Risk of Silent Small Vessel Disease in Patients Presenting With Acute Ischemic Stroke

et al. 2021

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“…The presence of peripheral artery disease is also an important marker for systemic atherosclerosis involving the coronary, cerebral, and renal vascular territories ( 29 ). Severe atherosclerosis could make the arterial wall less deformable, thereby impairing patients' BP-regulating capacity ( 30 ). Once the baroreflex-mediated BP regulation suffered, BP variability would increase, causing cardiovascular events ( 31 ).…”

Section: Discussionmentioning

confidence: 99%

Prediction of risk factors for intraoperative hypotension during general anesthesia undergoing carotid endarterectomy

et al. 2022

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ObjectiveCarotid endarterectomy (CEA) has been considered as “gold standard” treatment for patients with significant carotid stenosis Intra-operative hypotension was a risk factor for post-operative complications in patients undergoing CEA. This study aimed to investigate the predictors for intra-operative hypotension during CEA.MethodsThis retrospective study included consecutive patients underwent CEA from June 1, 2020 to May 31, 2021 in the neurosurgery department of Xuanwu Hospital, Capital Medical University. The intraoperative hypotension was defined as blood pressure (BP) of 20% below standard value for longer than 5 min. Univariable and multivariable analyses were performed to identify the prediction of risk factors for intraoperative hypotension.ResultsOverall, 367 patients were included, and 143 (39.0%) patients had hypotension during CEA procedure. Univariate analysis indicated Grade 3 hypertension (P = 0.002), peripheral artery disease (P = 0.006) and shunting (P = 0.049) were associated with occurrence of intraoperative hypotension during CEA procedure. On multivariable analysis, Grade 3 hypertension (P = 0.005), peripheral artery disease (P = 0.009), and shunting (P = 0.034) were all found to be independent predicting factors of hypotension during the CEA process.ConclusionIntraoperative hypotension is a dynamic phenomenon may be affected by patients with grade 3 hypertension, peripheral artery disease and intra-operative shunting. It is necessary to pay special attention to these patients, both intraoperatively and postoperatively, to improve the final clinical outcome.

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“…The Warfarin-Aspirin Symptomatic Intracranial Disease Trial (WASIDT) [ 19 ] was used to assess the luminal stenosis in the intracranial arteries, and the North American Symptomatic Carotid Endarterectomy Trial (NASCET) [ 20 ] was used to measure the luminal stenosis in the extracranial arteries. According to the degree of atherosclerotic plaques and stenosis, semi-quantitative score was used to evaluate atherosclerotic conditions (0, no atherosclerotic plaque; 1 atherosclerotic plaque without evident lumen stenosis or stenosis < 50%; 2, stenosis 50-69%; 3, stenosis 70-99%; 4, occlusion) [ 21 ]. The intracranial atherosclerotic burden was calculated through summing the intracranial atherosclerotic scores of intracranial arterial segments, which were categorized into four grades of 0, 1, 2–3, and ≥ 4 scores [ 21 ].…”

Section: Methodsmentioning

confidence: 99%

“…According to the degree of atherosclerotic plaques and stenosis, semi-quantitative score was used to evaluate atherosclerotic conditions (0, no atherosclerotic plaque; 1 atherosclerotic plaque without evident lumen stenosis or stenosis < 50%; 2, stenosis 50-69%; 3, stenosis 70-99%; 4, occlusion) [ 21 ]. The intracranial atherosclerotic burden was calculated through summing the intracranial atherosclerotic scores of intracranial arterial segments, which were categorized into four grades of 0, 1, 2–3, and ≥ 4 scores [ 21 ]. Similarly, the extracranial atherosclerotic burden was counted through extracranial arterial segments, and categorized into four grades of 0, 1, 2–3, and ≥ 4 scores[ 21 ].…”

Section: Methodsmentioning

confidence: 99%

Association between triglyceride glucose index and atherosclerotic plaques and Burden: findings from a community-based study

Wang

Mei

Jin

et al. 2022

Cardiovasc Diabetol

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Background Insulin resistance is an important cause of cardiovascular events and cerebral infarction development. We aimed to investigate the association of the triglyceride glucose (TyG) index with atherosclerotic burden and plaques in coronary, intra- and extracranial arteries in participants with non-diabetes, and compared the results with that of the homeostasis model assessment of insulin resistance (HOMA-IR). Methods Participants without diabetes in the PolyvasculaR Evaluation for Cognitive Impairment and vaScular Events (PRECISE) study were included. We categorized participants by tertiles of the TyG index and the concordance/discordance of the TyG index and HOMA-IR. Discordance was defined as a TyG index equal to or greater than the median and HOMA-IR less than the median, or vice versa. The atherosclerosis plaques and burden in coronary, intra- and extracranial arteries were evaluated. The association of HOMA-IR and TyG index with the presence of atherosclerotic plaques and atherosclerotic burden was assessed by binary and ordinal logistic regression models, respectively. Results Among 2,719 included participants, the average age was 60.9 (± 6.6) years, and 53.0% were female. Both TyG index and HOMA-IR were associated with increased odds of coronary/intra- and extracranial atherosclerotic plaques and burden after adjustment for age, sex, currenting smoking and drinking (all P < 0.05). However, the association between HOMA-IR and intracranial atherosclerosis was not statistically significant after adjustment for all potential confounders. Discordantly high TyG index with HOMA-IR had a higher odd of extracranial plaque (odds ratio [OR]: 1.34, 95% confidence interval [CI]: 1.04–1.71), extracranial atherosclerotic burden (common odds ratio [cOR]: 1.35, 95% CI 1.06–1.71), coronary plaque (OR: 1.30, 95% CI 1.01–1.68) and segment stenosis score (cOR: 1.39, 95% CI 1.09–1.78) as compared with concordantly low TyG index with HOMA-IR. The TyG index had a better net reclassification improvement ability than HOMA-IR for atherosclerotic plaques when adding to baseline model. Conclusion Elevated TyG index was associated with increased odds of atherosclerosis in coronary/intra- and extracranial arteries. Compared with HOMA-IR, the TyG index was more strongly associated with intracranial atherosclerosis. Moreover, discordantly high TyG index with HOMA-IR was also important for atherosclerosis identification.

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Total Atherosclerosis Burden of Baroreceptor-Resident Arteries Independently Predicts Blood Pressure Dipping in Patients With Ischemic Stroke

Abstract: Supplemental Digital Content is available in the text.

Cited by 18 publications

References 28 publications

Night-Time Non-dipping Blood Pressure and Heart Rate: An Association With the Risk of Silent Small Vessel Disease in Patients Presenting With Acute Ischemic Stroke

Night-Time Non-dipping Blood Pressure and Heart Rate: An Association With the Risk of Silent Small Vessel Disease in Patients Presenting With Acute Ischemic Stroke

Prediction of risk factors for intraoperative hypotension during general anesthesia undergoing carotid endarterectomy

Association between triglyceride glucose index and atherosclerotic plaques and Burden: findings from a community-based study

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