scholarly journals Night-time diastolic blood pressure variability relates to stroke recurrence in patients who had ischaemic stroke with small artery occlusion

2021 ◽  
pp. svn-2020-000718
Author(s):  
Tingting Wang ◽  
Jie Xu ◽  
Anxin Wang ◽  
Ying Liu ◽  
Xingquan Zhao ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischaemic Stroke ◽  
Blood Pressure Variability ◽  
Artery Occlusion ◽  
Stroke Recurrence ◽  
Large Artery ◽  
Small Artery ◽  
Night Time ◽  
Increased Risk ◽  
Small Artery Occlusion

Background and purposeThe association between blood pressure variability (BPV) and stroke recurrence among patients who had ischaemic stroke (IS) remains unclear. This study aimed to investigate the association between BPV and stroke recurrence in patients who had IS of large artery atherosclerosis (LAA) subtype and small artery occlusion (SAO) subtype.MethodsData from the BOSS (Blood Pressure and Clinical Outcome in Transient Ischemic Attack or Ischemic Stroke) study were examined. IS subtypes were diagnosed according to the Trial of Org 10172 in Acute Stroke Treatment criteria. BPV was performed by 24-hour ambulatory blood pressure monitoring and defined through SD of blood pressure. The primary outcome was stroke recurrence within 90 days after discharge. Multivariable Cox regression model was used to assess the association between BPV and stroke recurrence in patients who had IS of LAA subtype and SAO subtype.ResultsA total of 1390 patients who had IS from the BOSS study were included in the present study. Multivariable analysis suggests that 24-hour systolic BPV (SBPV) and night-time diastolic BPV (DBPV) were significantly associated with stroke recurrence among all patients who had IS (HR, 2.50, 95% CI 1.07 to 5.84; HR, 1.85, 95% CI 1.07 to 3.21, respectively). Night-time SBPV and night-time DBPV were significantly associated with stroke recurrence in patients with SAO subtype (HR, 2.77, 95% CI 1.07 to 7.15; HR, 3.60, 95% CI 1.39 to 9.29, respectively). However, in the adjusted model, only night-time DBPV remained significant in patients with SAO subtype (HR, 3.87, 95% CI 1.40 to 10.71). Similar results were not found in patients who had IS of LAA subtype.ConclusionsHigh night-time DBPV was associated with increased risk of stroke recurrence among patients who had IS of SAO subtype. The results of this study have implications for the secondary prevention management and future research of patients who had IS of SAO subtype. The association between BPV and stroke recurrence in patients who had IS of LAA subtype and SAO subtype should be investigated in larger, population-based studies.

Trimethylamine N-Oxide and Stroke Recurrence Depends on Ischemic Stroke Subtypes

Stroke ◽  
2021 ◽  
Author(s):  
Jie Xu ◽  
Aichun Cheng ◽  
Bo Song ◽  
Mingming Zhao ◽  
Jing Xue ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cox Regression ◽  
Meta Analysis ◽  
Artery Occlusion ◽  
Hazard Ratio ◽  
Stroke Recurrence ◽  
Large Artery ◽  
Small Artery ◽  
Increased Risk ◽  
Small Artery Occlusion

Background and Purpose: Trimethylamine N-oxide (TMAO) has been recognized as a risk factor for cardiovascular disease. However, the role of TMAO in ischemic stroke remains unclear. As we know, ischemic stroke is a heterogeneous disease with variable pathogenesis. Hence, we aimed to investigate the association between TMAO and stroke recurrence according to etiology subtypes. Methods: A total of 10 756 ischemic stroke/transient ischemic attack patients from the Third China National Stroke Registry were enrolled, and 1-year follow-up data for stroke recurrence were analyzed. TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria was used to classify the etiology subtypes. Plasma TMAO levels were quantified by liquid chromatography–mass spectrometry. The association between TMAO and stroke outcomes was analyzed using Cox regression models. We also conducted a meta-analysis on the association of TMAO levels and stroke risk. Results: Elevated TMAO level was independently associated with the risk of stroke recurrence (Q4 versus Q1: adjusted hazard ratio, 1.37 [95% CI, 1.15–1.64]) in multivariate Cox regression model. After stratification by TOAST subtypes, there was a significant association between TMAO and stroke recurrence in small artery occlusion subtype (adjusted hazard ratio, 1.43 [95% CI, 1.03–2.00]) but not in the others subtype (large-artery atherosclerosis, 1.19 [0.95–1.48]; cardioembolism, 1.54 [0.95–2.48]; others, 1.19 [0.98–1.44]). The meta-analysis reported on stroke recurrence for the highest versus lowest TMAO levels with a pooled hazard ratio of 1.66 (95% CI, 0.91–3.01) and similarly found an increased risk of stroke recurrence. Conclusions: Elevated TMAO level is associated with increased risk of stroke recurrence in patients with small artery occlusion subtype, but this association seems to be attenuated in large-artery atherosclerosis, cardioembolism, and others subtypes.

scholarly journals Detailed phenotyping of posterior vs. anterior circulation ischemic stroke: a multi-center MRI study

2019 ◽  
Vol 267 (3) ◽  
pp. 649-658 ◽  
Author(s):  
Petrea Frid ◽  
◽  
Mattias Drake ◽  
A. K. Giese ◽  
J. Wasselius ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Artery Occlusion ◽  
Large Artery ◽  
Small Artery ◽  
Anterior Circulation ◽  
Lesion Location ◽  
Stroke Subtypes ◽  
Small Artery Occlusion ◽  
Male Sex

Abstract Objective Posterior circulation ischemic stroke (PCiS) constitutes 20–30% of ischemic stroke cases. Detailed information about differences between PCiS and anterior circulation ischemic stroke (ACiS) remains scarce. Such information might guide clinical decision making and prevention strategies. We studied risk factors and ischemic stroke subtypes in PCiS vs. ACiS and lesion location on magnetic resonance imaging (MRI) in PCiS. Methods Out of 3,301 MRIs from 12 sites in the National Institute of Neurological Disorders and Stroke (NINDS) Stroke Genetics Network (SiGN), we included 2,381 cases with acute DWI lesions. The definition of ACiS or PCiS was based on lesion location. We compared the groups using Chi-squared and logistic regression. Results PCiS occurred in 718 (30%) patients and ACiS in 1663 (70%). Diabetes and male sex were more common in PCiS vs. ACiS (diabetes 27% vs. 23%, p < 0.05; male sex 68% vs. 58%, p < 0.001). Both were independently associated with PCiS (diabetes, OR = 1.29; 95% CI 1.04–1.61; male sex, OR = 1.46; 95% CI 1.21–1.78). ACiS more commonly had large artery atherosclerosis (25% vs. 20%, p < 0.01) and cardioembolic mechanisms (17% vs. 11%, p < 0.001) compared to PCiS. Small artery occlusion was more common in PCiS vs. ACiS (20% vs. 14%, p < 0.001). Small artery occlusion accounted for 47% of solitary brainstem infarctions. Conclusion Ischemic stroke subtypes differ between the two phenotypes. Diabetes and male sex have a stronger association with PCiS than ACiS. Definitive MRI-based PCiS diagnosis aids etiological investigation and contributes additional insights into specific risk factors and mechanisms of injury in PCiS.

Bilateral sphenopalatine ganglion block reduces blood pressure and blood pressure variability in never treated patients with essential hypertension

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Triantafyllidi ◽  
C Arvaniti ◽  
D Benas ◽  
A Schoinas ◽  
D Voutsinos ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Essential Hypertension ◽  
Blood Pressure Variability ◽  
Control Group ◽  
Sham Operation ◽  
Study Group ◽  
Sphenopalatine Ganglion ◽  
Night Time ◽  
Hypertensive Patients ◽  
Increased Risk

Abstract Background Sphenopalatine ganglion (SPG) area is connected through sympathetic fibers with the central nervous system. It is already known that SPG infiltration by lidocaine reduced blood pressure in naïve hypertensive patients. Blood pressure variability (BPV) has been associated with an increased risk of cardiovascular events and mortality, independently of elevated BP levels. We aimed to study the effect of SPG block in BPV in never treated patients with stage I–II essential hypertension. Methods We performed bilateral SPG block with lidocaine 2% in 47 newly diagnosed and never treated hypertensive patients (study group, mean age 50±12 years, 31 men) and a sham operation with water for injection in 11 patients (control group, mean age 51±12 years, 8 men). All patients have been subjected to 24 hour ambulatory blood pressure monitoring (ABPM) prior and a month after the SPG block in order to estimate any differences in BP parameters derived from ABPM (BP, BPV). We defined as responders to SBG block those patients with a 24h average SBP decrease &gt;5 mmHg. Results We noticed the following significant differences in the study group: a. 24h average DBP and daytime DBP were reduced by 1.6±5 mmHg (p=0.04) and 1.9±5 mmHg (p=0.01) respectively and b. systolic BPV during daytime (11±2 mmHg vs. 10±2 mmHg, p&lt;0.05). Interestingly, in the responders group (14/47, 30%, 9 men, age = 47±8 mmHg) and a month after SPG block we noticed that: a. 24h average, daytime, night-time SBP and 24h average, daytime, night-time DBP were reduced by 9±4 mmHg (p&lt;0.001), 9±3 mmHg (p&lt;0.001), 7±7 mmHg (p=0.002) and 6.5±3 mmHg (p&lt;0.001), 6.5±3 mmHg (p&lt;0.001), 4±7 mmHg (p=0.02), respectively and b. systolic BPV during daytime (13±2 mmHg vs. 9±2 mmHg, p=0.01). No differences regarding BPV were found in the non-responders and the sham operation group. Conclusions SPG block is a promising, minimally invasive option of significant BP and BPV decrease in never treated hypertensive patients, especially during daytime activities when SNS is activated. It acts probably through SNS modulation. Since its effect is only anesthetic and non-permanent, SPG block might permit the selection of the hypertensive patients with an activated SNS before any other invasive antihypertensive procedure. SPG block reduces BP variability Funding Acknowledgement Type of funding source: None

scholarly journals Contemporary approach to diagnosis of ischemic stroke pathogenetic variants in patients with atherosclerosis and arterial hypertension

2020 ◽  
Author(s):  
PL Anufriev ◽  
MM Tanashyan ◽  
TS Gulevskaya
Keyword(s):  
Ischemic Stroke ◽  
Artery Occlusion ◽  
Large Artery ◽  
Small Artery ◽  
Arterial Embolism ◽  
Morphological Criteria ◽  
Small Artery Occlusion ◽  
Examination Methods ◽  
Toast Classification ◽  
Instrumental Methods

The angio- and neurovisualization methods vigorously developing in recent decades determine the relevance of improvement of etiopathogenetic ischemic stroke classification used for the treatment tactics selection and for secondary prevention of the disorder. The study was aimed to clarify the capabilities of clinical diagnosis for pathogenetic variants of ischemic stroke. For that, in 125 postmortem cases, the macro and microscopic examination of brain and cardiovascular system was carried out in order to verify the stroke pathogenesis established as a result of the previous patients’ examination. The study demonstrates the great potential of the major pathogenetic stroke subtypes (large-artery atherosclerosis, cardioembolism, small-artery occlusion) diagnosis using the complex of contemporary clinical and instrumental methods and the main morphological criteria of these subtypes in accordance with the TOAST classification. Moreover, the clinical and pathomorphological assessment allowed us to differentiate stroke resulting from various alterations of single cerebral artery, the atherothrombotic occlusion (44% of cases for the subtype), arterio-arterial embolism (13%) and critical stenosis (10%), as well as stroke resulting from cerebrovascular insufficiency (33%), within the “large-artery atherosclerosis” subtype. Thus, the high informativity of the existing examination methods allows for a more differentiated understanding of the cause of ischemic stroke, which is fully in line with modern personalized medicine.

scholarly journals Targeting von Willebrand Factor in Ischaemic Stroke: Focus on Clinical Evidence

2018 ◽  
Vol 118 (06) ◽  
pp. 959-978 ◽  
Author(s):  
Nina Buchtele ◽  
Michael Schwameis ◽  
James Gilbert ◽  
Christian Schörgenhofer ◽  
Bernd Jilma
Keyword(s):  
Ischaemic Stroke ◽  
Von Willebrand Factor ◽  
Prediction Models ◽  
Stroke Recurrence ◽  
Large Artery ◽  
Potential Target ◽  
Increased Risk ◽  
Von Willebrand ◽  
Willebrand Factor

AbstractDespite great efforts in stroke research, disability and recurrence rates in ischaemic stroke remain unacceptably high. To address this issue, one potential target for novel therapeutics is the glycoprotein von Willebrand factor (vWF), which increases in thrombogenicity especially under high shear rates as it bridges between vascular sub-endothelial collagen and platelets. The rationale for vWF as a potential target in stroke comes from four bodies of evidence. (1) Animal models which recapitulate the pathogenesis of stroke and validate the concept of targeting vWF for stroke prevention and the use of the vWF cleavage enzyme ADAMTS13 in acute stroke treatment. (2) Extensive epidemiologic data establishing the prognostic role of vWF in the clinical setting showing that high vWF levels are associated with an increased risk of first stroke, stroke recurrence or stroke-associated mortality. As such, vWF levels may be a suitable marker for further risk stratification to potentially fine-tune current risk prediction models which are mainly based on clinical and imaging data. (3) Genetic studies showing an association between vWF levels and stroke risk on genomic levels. Finally, (4) studies of patients with primary disorders of excess or deficiency of function in the vWF axis (e.g. thrombotic thrombocytopenic purpura and von Willebrand disease, respectively) which demonstrate the crucial role of vWF in atherothrombosis. Therapeutic inhibition of VWF by novel agents appears particularly promising for secondary prevention of stroke recurrence in specific sub-groups of patients such as those suffering from large artery atherosclerosis, as designated according to the TOAST classification.

Abstract 16476: Visit-to-Visit Blood Pressure Variability is Associated With Incident Frailty: The Multidomain Alzheimer Preventive Trial (MAPT)

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Laure Rouch ◽  
Philipe de Souto Barreto ◽  
Olivier Hanon ◽  
Jacques Amar ◽  
Yves Rolland ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Standard Deviation ◽  
Blood Pressure Variability ◽  
Proportional Hazards ◽  
Antihypertensive Drugs ◽  
Cox Proportional Hazards ◽  
Community Dwelling ◽  
Clinical Predictors ◽  
Increased Risk ◽  
Preventive Trial

Introduction: Visit-to-visit blood pressure variability (BPV) has been associated with greater cardiovascular and all-cause mortality, cognitive impairment, and incident dementia. It may also represent a decline in homeostatic mechanisms in blood pressure (BP) regulation associated with frailty, one of the most problematic expression of population aging. Hypothesis: We hypothesized that visit-to-visit systolic (SBPV), diastolic (DBPV), mean arterial (MAPV) and pulse pressure (PPV) variability are associated with greater incident frailty. Methods: We included 1,394 non-frail community-dwelling participants aged ≥ 70 years from the Multidomain Alzheimer Preventive Trial (MAPT) who underwent repeated clinical examinations over a 5-year follow-up period. SBPV, DBPV, MAPV and PPV were evaluated using standard deviation, coefficient of variation (CV), average real variability, successive variation, variation independent of mean and residual standard deviation. Incident frailty was assessed using the Fried phenotype. Cox proportional hazards models were used for the analyses. Results: Higher SBPV was significantly associated with increased risk of incident frailty (1-sd increase of CV: HR = 1.18, 95% CI [1.02-1.37], p=0.03) after adjustment for demographics, body mass index, stroke, ischemic heart disease, diabetes, heart failure, antihypertensive drugs, systolic BP, MAPT intervention groups and baseline pre-frail status. Similar results were observed with all indicators of variability. DBPV and MAPV were not associated with incident frailty (p=0.6 and p=0.2, respectively). Interestingly, higher PPV was also associated with a greater risk of developing frailty over time (1-sd increase of CV: HR = 1.17, 95% CI [1.01-1.35], p=0.03). Conclusion: Independently of BP, higher SBPV and PPV are major clinical predictors of incident frailty. Our findings support the concept of BP physiological dysregulation underlying the frail state and suggest that controlling BP instability could be a promising interventional target in preventing frailty.

Abstract MP33: Association Between Neurologic Outcomes and Temporal Profile of Systolic Blood Pressure Variability After Endovascular Thrombectomy

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Ayush Prasad ◽  
Jessica Kobsa ◽  
Sreeja Kodali ◽  
Cindy Khanh Nguyen ◽  
Darko Quispe Orozco ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Standard Deviation ◽  
Systolic Blood Pressure ◽  
Functional Outcome ◽  
Blood Pressure Variability ◽  
Treatment Strategies ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Increased Risk ◽  
Systolic Blood Pressure Variability

Introduction: Higher systolic blood pressure variability (BPV) after endovascular thrombectomy (EVT) has been associated with an increased risk of hemorrhagic transformation and worse functional outcomes. However, the time-varying behavior of BPV after EVT and its effects on functional outcome have not been well characterized. Methods: We analyzed data from an international cohort of patients with acute large-vessel occlusion stroke who underwent EVT at 11 centers across North America, Europe, and Asia. Repeated time-stamped blood pressure data were recorded for the first 72 hours after thrombectomy. Parameters of BPV were calculated in 12-hour epochs using five established methodologies: standard deviation (SD), coefficient of variation (CV), average real variability (ARV), successive variation (SV), and residual SD (rSD). Patients’ overall mean BPV was then used to assign patients into tertiles for regression analysis: low BPV, intermediate BPV, and high BPV. Functional outcome was measured with the modified Rankin Scale (mRS) at 90 days. Results: Of the 1,791 patients (age 69 ± 14, NIHSS 15 ± 6) included in our analysis, 1,085 (60.6%) had a poor 90-day outcome (mRS >3). Patients with poor outcome had significantly higher systolic BPV (p<0.05) measured as standard deviation (SBP SD) at each epoch (Figure 1B). Compared to patients with low BPV, those in the highest tertile group had significantly greater odds of a poor functional outcome after adjusting for age, sex, hypertension, NIHSS, ASPECT, tPA, time to reperfusion, and TICI score (OR 1.5; 95% CI 1.2-2; p=0.001). Patients in the highest tertile of BPV demonstrated time-dependent variability with the highest SBP SD during the first 24 hours after thrombectomy (Figure 1A). Conclusions: Higher BPV measured by SBP SD appears to be associated with poor 90-day outcome in EVT-treated stroke patients. Early treatment strategies targeting early high BPV warrant further prospective investigation.

Abstract WP218: Increased Systolic Blood Pressure Variability Among Diabetic Patients is Associated With Higher Risk of Incident Stroke: A Secondary Analysis of ACCORDION

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Adam H de Havenon ◽  
Ka-Ho Wong ◽  
Eva Mistry ◽  
Mohammad Anadani ◽  
Shadi Yaghi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Variability ◽  
Proportional Hazards ◽  
Secondary Analysis ◽  
Cox Proportional Hazards ◽  
Diabetic Patients ◽  
Adjusted Risk ◽  
Cox Proportional Hazards Models ◽  
Increased Risk

Background: Increased blood pressure variability (BPV) has been associated with stroke risk, but never specifically in patients with diabetes. Methods: This is a secondary analysis of the Action to Control Cardiovascular Risk in Diabetes Follow-On Study (ACCORDION), the long term follow-up extension of ACCORD. Visit-to-visit BPV was analyzed using all BP readings during the first 36 months. The primary outcome was incident ischemic or hemorrhagic stroke after 36 months. Differences in mean BPV was tested with Student’s t-test. We fit Cox proportional hazards models to estimate the adjusted risk of stroke across lowest vs. highest quintile of BPV and report hazard ratios along with 95% confidence intervals (CI). Results: Our analysis included 9,241 patients, with a mean (SD) age of 62.7 (6.6) years and 61.7% were male. Mean (SD) follow-up was 5.7 (2.4) years and number of BP readings per patient was 12.0 (4.3). Systolic, but not diastolic, BPV was higher in patients who developed stroke (Table 1). The highest quintile of SBP SD was associated with increased risk of incident stroke, independent of mean blood pressure or other potential confounders. (Table 2, Figure 1). There was no interaction between SBP SD and treatment arm assignment, although the interaction for glucose approached significance (Table 2). Conclusion: Higher systolic BPV was associated with incident stroke in a large cohort of diabetic patients. Future trials of stroke prevention may benefit from interventions targeting BPV reduction.

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