scholarly journals Hypertension and Its Impact on Stroke Recovery: From a Vascular to a Parenchymal Overview

2019 ◽  
Vol 2019 ◽  
pp. 1-14 ◽  
Author(s):  
Benjamin Maïer ◽  
Nathalie Kubis
Keyword(s):  
Risk Factor ◽  
Vascular Risk Factor ◽  
Vascular Cognitive Impairment ◽  
Stroke Recovery ◽  
Stroke Outcome ◽  
Vascular Risk ◽  
Cell Responses ◽  
The Impact ◽  
Worse Prognosis

Hypertension is the first modifiable vascular risk factor accounting for 10.4 million deaths worldwide; it is strongly and independently associated with the risk of stroke and is related to worse prognosis. In addition, hypertension seems to be a key player in the implementation of vascular cognitive impairment. Long-term hypertension, complicated or not by the occurrence of ischemic stroke, is often reviewed on its vascular side, and parenchymal consequences are put aside. Here, we sought to review the impact of isolated hypertension or hypertension associated to stroke on brain atrophy, neuron connectivity and neurogenesis, and phenotype modification of microglia and astrocytes. Finally, we discuss the impact of antihypertensive therapies on cell responses to hypertension and functional recovery. This attractive topic remains a focus of continued investigation and stresses the relevance of including this vascular risk factor in preclinical investigations of stroke outcome.

Abstract T P165: Women Had Worse Stroke Outcome

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Claudia Alonzo ◽  
Maria C Zurru ◽  
Laura Brescacin ◽  
Santiago Pigretti ◽  
Pedro Colla Machado ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Ischemic Stroke ◽  
Vascular Risk Factor ◽  
Stroke Outcome ◽  
Vascular Risk ◽  
Stroke Patients ◽  
Stroke Outcomes ◽  
Post Stroke ◽  
Artery Disease

Background: women who have ischemic strokes are on average older than men.Several studies, however, show that stroke outcomes are worse in women even after adjusting for age, and the specific conditions that contribute to this outcome are poorly known. Our objective was to evaluate post-stroke disability and mortality after ischemic stroke in women. Methods: acute ischemic stroke patients were prospectively included in a multidisciplinary secondary stroke prevention program. Pre-stroke vascular risk factor profile and control were obtained from electronic records; disability (modified Rankin scale) were evaluated one month after stroke. Results: fifty seven percent of the 1194 ischemic stroke patients prospectively included between December 2006 and December 2013 were women. They were older, more probably hypertensive, dislipidemic and diabetic, and had higher incidence of atrial fibrillation, while men had higher prevalence of obesity, metabolic syndrome, smoking, and history of coronary heart disease and peripheral artery disease. Pre-stroke vascular risk factor control and management are shown in table 1. Women had worst outcome than men: mRankin >1 (66% women vs 52% men, p 0.0001), 30-day mortality (4% women vs 2% men, p 0.04), composite disability + mortality (52% women vs 36% men, p 0.0001). After adjusting by age women still had higher risk of disability and mortality: m-Rankin >1 (OR 1.40, 95%CI 1.05-1.87; p 0.02); mortality (OR 1.64, 95%CI 0,98-2,74), and composite disability + mortality (OR 1.59, 95%CI 1.22-2.07; p 0.004). Conclusion: in our cohort women have worst post-stroke outcome, even though they have higher burden of vascular risk factors they have lower prevalence of vascular disease in other vascular beds previous to stroke. This difference persists after adjusting by age, raising the possibility of specific gender risk factors influencing on ischemic stroke outcomes.

Abstract 3133: Impact of Post-stroke Isolation on Stroke Outcome

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Venugopal R Venna ◽  
Yan Xu ◽  
Jun Li ◽  
Fudong Liu ◽  
Louise D McCullough
Keyword(s):  
Infarct Size ◽  
Functional Recovery ◽  
Forced Swim Test ◽  
Statistical Significance ◽  
Experimental Studies ◽  
Stroke Recovery ◽  
Stroke Outcome ◽  
Post Stroke ◽  
The Impact

Background: Psychosocial factors are increasingly accepted as critical factors in post-stroke recovery, mortality and morbidity. Although, emerging data from clinical and population based studies support the role of social support in improved functional recovery and reducing the risk of mortality, to date no experimental studies have investigated such effects in post-stroke animal models. The aim of this study is to investigate for the impact of post stroke housing and the effects of long-term social isolation and pair housing with either a healthy or a stroked partner, and explored for the mechanisms. Methods: Male mice (20-25g; C57BL/6N, Charles River Labs), all initially pair housed, were subjected to right middle cerebral artery occlusion (MCAO - 60min) and then randomly assigned to a specific housing condition - isolated, paired with a stroke partner or paired with a healthy partner. Infarct size was quantified with TTC 72h after stroke (n=8/grp). We then investigated the effects of housing on long-term functional recovery using corner test, cylinder test, forced swim test (FST) and tail suspension test (TST). We further explored the mechanisms underlying the improved behavioral recovery by injecting BrDU 150mg/kg/day i.p. for 5 days starting from day 3 post-stroke (n=8/grp), and assessing changes in BDNF levels by western-blot analysis (n=4/grp). Data were expressed as mean±sem. Two-way ANOVA was performed and P value < .05 was set for statistical significance. Results: Post-stroke housing conditions can significantly impact infarct size; we observed that mice isolated after stroke had increased infarct volume compared to pair housed mice in all three brain regions (Cortex: 63.2±2.5 vs 40.0±6.2; p<0.01); (Striatum: 86.6±2.2 vs 67.7±2.9; p<0.01); (Total: 60.9±1.3 vs 32.6±4.3; p<0.01). Although post-stroke housing with healthy vs a stroked partner did not influenced infarct size (p>0.05), animals pair housed with healthy partner showed a significantly improved functional recovery by as early as day 15 in the cylinder and corner tests (p<0.05). Increased mobility was observed in FST and TST in PH mice compared to SI mice at day 90 (p<0.05). Consistently, housing with a healthy partner increased BrDU positive cells (p<0.05) and enhanced BDNF expression compared to other cohorts (SI 1±0.1; PH with stroke partner 1.9±0.2; PH with healthy partner 2.6±0.1; n=4/grp), no changes were seen in sham mice. Conclusions: Post-stroke housing has an important impact on stroke outcome; isolation has a detrimental effect on infarct size compared to pair housed cohorts. Interestingly, independent of infarct size, housing with a healthy partner hastened recovery compared to those stroke mice housed with partner that had also been subjected to stroke. Molecular analysis indicates the involvement of BDNF and neurogenesis may be important regulators of post-stroke housing induced functional recovery.

Vascular cognitive impairment

2020 ◽  
pp. 454-463
Author(s):  
Joanne A. Byars ◽  
Ricardo E. Jorge
Keyword(s):  
Risk Factor ◽  
Cognitive Impairment ◽  
Vascular Risk Factor ◽  
Vascular Cognitive Impairment ◽  
Severe Form ◽  
Functional Change ◽  
Vascular Pathology ◽  
Vascular Risk ◽  
Risk Factor Modification ◽  
Factor Modification

Vascular cognitive impairment (VCI)—vascular dementia (VasD) in its severe form—is cognitive impairment due to cerebral ischaemic or haemorrhagic disease. VasD is the second most common cause of dementia in the United States. VCI and Alzheimer’s disease can coexist and synergistically worsen each other. Clinical features of VCI can vary, depending on which areas of the brain the vascular pathology affects. Individuals without a history of clinical stroke can still have VCI; small-vessel cerebrovascular disease can present as an insidious cognitive decline, rather than an abrupt functional change. Neuroimaging plays a key role in diagnosing VCI and distinguishing it from other aetiologies of cognitive impairment. Aggressive vascular risk factor modification helps prevent VCI and improves outcomes in VCI, and represents the most important intervention for this condition. Early detection of VCI maximizes the effectiveness of vascular risk factor modification. Cholinesterase inhibitors and memantine may offer some cognitive benefit in VCI.

Vascular risk factor and vascular cognitive impairment: What is the relationship?

2000 ◽  
Vol 21 ◽  
pp. 170
Author(s):  
Kellee A. Howard ◽  
Susan A. Kirkland ◽  
Patrick R. Montgomery ◽  
David Hogan ◽  
Howard Feldman ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cognitive Impairment ◽  
Vascular Risk Factor ◽  
Vascular Cognitive Impairment ◽  
Vascular Risk ◽  
The Relationship

Abstract WMP14: Association of Systolic Blood Pressure, LDL Cholesterol, and Hgb A1c With White Matter Hyperintensity on MRI in the ACCORDION MIND Study

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Adam H de Havenon ◽  
Tanya Turan ◽  
Rebecca Gottesman ◽  
Sharon Yeatts ◽  
Shyam Prabhakaran ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Risk Factor ◽  
Regression Models ◽  
Ldl Cholesterol ◽  
Vascular Risk Factor ◽  
White Matter Hyperintensity ◽  
Vascular Risk ◽  
Linear Regression Models ◽  
Risk Factor Profile ◽  
The Mean

Introduction: While retrospective studies have shown that poor control of vascular risk factors is associated with progression of white matter hyperintensity (WMH), it has not been studied prospectively. Hypothesis: We hypothesize that higher systolic blood pressure (SBP) mean, LDL cholesterol, and Hgb A1c will be correlated with WMH progression in diabetics. Methods: This is a secondary analysis of the Memory in Diabetes (MIND) substudy of the Action to Control Cardiovascular Risk in Diabetes Follow-on Study (ACCORDION). The primary outcome was WMH progression, evaluated by fitting linear regression models to the WMH volume on the month 80 MRI and adjusting for the WMH volume on the baseline MRI. The primary predictors were the mean values of SBP, LDL, and A1c from baseline to month 80. We defined a good vascular risk factor profile as mean SBP <120 mm Hg and mean LDL <120 mg/dL. Results: We included 292 patients, with a mean (SD) age of 62.6 (5.3) years and 55.8% male. The mean number of SBP, LDL, and A1c measurements per patient was 17, 5, and 12. We identified 86 (29.4%) patients with good vascular risk factor profile. In the linear regression models, mean SBP and LDL were associated with WMH progression and in a second fully adjusted model they both remained associated with WMH progression (Table). Those with a good vascular risk factor profile had less WMH progression (β Coefficient -0.80, 95% CI -1.42, -0.18, p=0.012). Conclusions: Our data reinforce prior research showing that higher SBP and LDL is associated with progression of WMH in diabetics, likely secondary to chronic microvascular ischemia, and suggest that control of these factors may have protective effects. This study has unique strengths, including prospective serial measurement of the exposures, validated algorithmic measurement methodology for WMH, and rigorous adjudication of study data. Clinical trials are needed to investigate the effect of vascular risk factor reduction on WMH progression.

Abstract 121: Vascular Risk Factor Control in the Year After Ischemic Stroke Versus Myocardial Infarction

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Dawn M Bravata ◽  
Jared Brosch ◽  
Jason Sico ◽  
Fitsum Baye ◽  
Laura Myers ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Risk Factor ◽  
Ischemic Stroke ◽  
Standard Deviation ◽  
Vascular Risk Factor ◽  
Vascular Risk ◽  
Hypertension Control ◽  
Stroke Patients ◽  
Risk Factor Control ◽  
Facility Level

Background: The Veterans Health Administration has multiple quality improvement activities directed at improving vascular risk factor control. We sought to examine facility quality of blood pressure (BP) control (<140/90 mm Hg), lipid control (LDL-cholesterol <100 mg/dL) and glycemic control (HbA1c <9%) in the one-year after hospitalization for ischemic stroke or acute myocardial infarction (AMI). Methods: We assembled a retrospective cohort of patients hospitalized with stroke or AMI (fiscal year 2011). Facilities were included if they admitted ≥25 stroke patients and ≥25 AMI patients. A facility-level consolidated measure of vascular risk factor control was calculated for the 3 processes of care (number of passes divided by number of opportunities). Results: A total of 2432 patients had a new stroke and 4873 had a new primary AMI (at 75 facilities). Stroke patients had worse vascular risk factor control than AMI patients (mean facility rate on consolidated measure: stroke, 70% [95%CI 0.68-0.72] vs AMI, 77% [0.75-0.78]). The greatest disparity between stroke and AMI patients was in hypertension control: at 87% of hospitals, fewer stroke patients achieved BP control than AMI patients (mean facility pass rate: stroke, 41% vs AMI, 52%; p<0.0001). Overall there were no statistical differences for stroke versus AMI patients in facility-level hyperlipidemia control (71% vs 73%, p=0.33) and glycemic control (79% versus 82%, p=0.24). AMI patients had more outpatient visits than stroke patients in the year after discharge [AMI: mean 7.9 visits (standard deviation 6.1)]; stroke: mean 6.0 visits (standard deviation 4.5; p<0.0001].); the primary difference in outpatient utilization was additional cardiology visits for AMI patients (2.5 visits with cardiology per AMI patient vs 0.4 visits per stroke patient; p<0.001). Conclusions: These results demonstrated clinically substantial disparities in hypertension control among patients with stroke vs patients with AMI. It may be that cardiologists provided risk factor management to AMI patients that stroke patients did not receive. The etiology of these observed differences merits additional investigation.

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