Covariates of non-dipping and elevated night-time blood pressure in ischemic stroke patients: the Norwegian Stroke in the Young Study*

Background: Hypertension is considered major risk factor for incidence of ischemic stroke, controlling blood pressure reduces this risk, the relationship of uncontrolled blood pressure and stroke outcomes is complex, post stroke uncontrolled blood pressure remains one of the major contributing factors for stroke recurrence and mortality, in our study we studied the long term effects of uncontrolled hypertension in modern health care setting. Methodology: Patients in the study were admitted to the neurology department at KFSH-D between March 2015- August 2019, we included 102 acute ischemic stroke patients whom had hypertension, all patients had follow up appointments at stroke clinic a minimum of 2 visits over 4 years. We retrospectively compared blood pressure data from stroke patients with recurrent ischemic stroke events vs. patients with initial stroke event, and recurrent stroke, also we studied blood pressure readings for different stroke severity groups, patients who had severe stroke with mRS>4, compared to milder stroke group of mRS<4. Results: We found 48 patients identified with recurrent stroke event, those with uncontrolled hypertension had significantly higher stroke recurrence events (P=0.002), despite acute stroke treatment, patients who had history of uncontrolled hypertension were found to have more severe stroke deficits than those who had controlled blood pressure (P=0.029). We found significant difference in the long term stroke clinical outcomes between patients who had uncontrolled blood pressure and patients who had controlled blood pressure recordings within the same hospital setting (P=0.064). Conclusion: Based on our findings, uncontrolled hypertension was associated with higher risk of stroke recurrence, it also increased susceptibility to worse stroke clinical outcomes up to 1 year after initial stroke event, which deserved further close attention and better blood pressure control.

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Abstract 69: Distinct Grouping of Systolic Blood Pressure Trajectories During the First 24 Hours After Stroke Admission and Their Outcomes

Stroke ◽

10.1161/str.48.suppl_1.69 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Beom Joon Kim ◽

Moon-Ku Han ◽

Yong-Jin Cho ◽

Keun-Sik Hong ◽

Jun Lee ◽

...

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Systolic Blood Pressure ◽

Age At Onset ◽

Stroke Patients ◽

Vascular Events ◽

Group 4 ◽

Group 3 ◽

Group 2 ◽

Group 1

Background: Blood pressure of ischemic stroke patients is a potentially modifiable clinical prognostic factor during acute period. However, BP changes dynamically over time and its temporal variation during acute stage has not received much attention. Methods: From a total of 3795 acute ischemic stroke patients who arrived within 24 hours after onset, we selected 2723 eligible patients who had more than 5 systolic blood pressure (SBP) measurements during 24 hours after arrival. To predict group SBPs for 8 time-points during the first 24 hours, a measured SBP reading was imputed to the nearest missing point. Trajectory grouping of acute stroke patients was estimated using PROC TRAJ, with delta BIC and prespecified modeling parameters. Early neurological deterioration (END) was captured during admission and recurrent vascular events was collected through a structured telephone interview at 1 years after. Results: Of the included cases, mean age at onset was 68 ± 13 year-old. NIHSS score at arrival was median 4 [2, 10] and recanalization treatment was done in 598 (22%). Hypertension was diagnosed in 1930 (71%). Based on 48,445 SBP readings during the first 24 hours after arrival, stroke cases were grouped into 5 distinct SBP trajectories as shown in the Figure: Group 1 (low BP), 17%; Group 2 (stable BP), 41%; Group 3 (rapidly stabilized SBP), 11%; Group 4 (higher SBP), 23%; Group 5 (extremely high SBP without stabilization), 8%. Trajectory grouping was independently associated with END and recurrent vascular events (see Figure). Group 1 had low odds of having END (adjusted OR [95% CI]; 0.62 [0.44-0.87], but Group 4 and 5 showed higher probability of having END (1.34 [1.04-1.73] and 1.76 [1.22-2.51]) and recurrent vascular events until 1 year (1.28 [1.00-1.64] and 1.82 [1.29-2.55]). However, Group 3 had comparable risks with Group 2. Conclusion: It was documented that SBP may successfully grouped into distinct trajectories, which are associated with outcomes after stroke.

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Abstract W P146: Low Serum Level of Eicosapentanoic Acid (EPA) is Associated with Occurrence of Nonlobar Type Intracerebal Hemorrhage (ICH)

Stroke ◽

10.1161/str.45.suppl_1.wp146 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Yasuhisa Akaiwa ◽

Hiroki Takano ◽

Hiroyuki Arakawa ◽

Itaru Ninomiya ◽

Masahiro Uemura ◽

...

Keyword(s):

Blood Pressure ◽

Fatty Acids ◽

Ischemic Stroke ◽

Polyunsaturated Fatty Acids ◽

Small Vessel Disease ◽

Routine Practice ◽

Large Artery ◽

Omega 3 ◽

Stroke Patients ◽

Stroke Subtypes

Background: : Intake of omega-3 polyunsaturated fatty acids, such as EPA, has been reported to have protective effects on various diseases including ischemic stroke. However, there have been few studies concerning the effect of omega-3 polyunsaturated fatty acids on hemorrhagic stroke. We studied associations of serum levels of EPA with stroke subtypes including primary ICH Methods: We have examined serum EPA and arachidonic acid (AA) levels in routine practice since 2009. To calibrate the EPA values, we calculated EPA/AA ratio. A total of 212 consecutive acute stroke patients and 27 control subjects were included. The patients 40 years old or younger were excluded. Ischemic stroke subtypes were determined based on TOAST criteria. Primary ICH was classified into lobar or nonlobar types, according to the region of the brain in which it occurred. Results: Of all the 157 ischemic stroke patients (female 47, mean age 72.9 years), 62 were classified with cardioembolic stroke (CES), 25 large-artery atherosclerotic (LAA), 22 small-vessel disease (SVD), and 48 other/undetermined causes (O/U). Of all the 55 ICH patients (female 23, mean age 71.0), 34 patients had nonlobar type, and 21 had lobar one. There were no significant intergroup differences in the mean EPA/AA ratio (p=0.525) among CES (EPA/AA= 0.67±0.42), LAA (0.70±0.30), SVD (0.65±0.45), O/U (0.62±0.38), nonlobar ICH (0.51±0.30), lobar ICH (0.64±0.33), and control (0.60±0.42) groups. However, the EPA/AA ratio of the nonlobar ICH group was considerably low. The EPA/AA ratio of the nonlobar ICH group was significantly (p=0.033) lower than that of the whole other groups (0.65±0.39) and significantly (p=0.003) lower than that of the entire ischemic stroke groups (0.67±0.40). Although the significant differences between the nonlobar ICH and the whole ischemic groups were also observed in systolic and diastolic blood pressure (195±37/107±25 mmHg vs 159±35/82±19 mmHg, p<0.001), multiple linear regression analyses showed the association between the EPA/AA and nonlobar ICH was independent from the blood pressure. Conclusions: Although the strongest risk factor for nonlobar ICH is hypertension, low EPA/AA ratio might play a role in the development of nonlobar ICH.

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Association of Elevated Blood Pressure Levels with Outcomes in Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis: A Systematic Review and Meta-Analysis

Journal of Stroke ◽

10.5853/jos.2018.02369 ◽

2019 ◽

Vol 21 (1) ◽

pp. 78-90 ◽

Cited By ~ 15

Author(s):

Konark Malhotra ◽

Niaz Ahmed ◽

Angeliki Filippatou ◽

Aristeidis H. Katsanos ◽

Nitin Goyal ◽

...

Keyword(s):

Systematic Review ◽

Blood Pressure ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Meta Analysis ◽

Intravenous Thrombolysis ◽

Elevated Blood Pressure ◽

Elevated Blood ◽

Stroke Patients

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Mortality and Disability According to Baseline Blood Pressure in Acute Ischemic Stroke Patients Treated by Thrombectomy: A Collaborative Pooled Analysis

Journal of the American Heart Association ◽

10.1161/jaha.117.004193 ◽

2017 ◽

Vol 6 (12) ◽

Cited By ~ 5

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Pooled Analysis ◽

Stroke Patients ◽

Baseline Blood Pressure

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The Association of Blood Pressure and Collateral Circulation in Hyperacute Ischemic Stroke Patients Treated with Intravenous Thrombolysis

Cerebrovascular Diseases ◽

10.1159/000371339 ◽

2015 ◽

Vol 39 (2) ◽

pp. 130-137 ◽

Cited By ~ 17

Author(s):

Harri Rusanen ◽

Jukka T. Saarinen ◽

Niko Sillanpää

Keyword(s):

Blood Pressure ◽

Multivariate Analysis ◽

Ischemic Stroke ◽

Mean Arterial Pressure ◽

Clinical Outcome ◽

Thrombolytic Therapy ◽

Systolic Blood Pressure ◽

Pulse Pressure ◽

Collateral Circulation ◽

Stroke Patients

Background: The integrity of collateral circulation is a major prognostic factor in ischemic stroke. Patients with good collateral status have larger penumbra and respond better to intravenous thrombolytic therapy. High systolic blood pressure is linked with worse clinical outcome in patients with acute ischemic stroke treated with intravenous thrombolytic therapy. We studied the effect of different blood pressure parameters on leptomeningeal collateral circulation in patients treated with intravenous thrombolytic therapy (<3 h) in a retrospective cohort. Methods: Anterior circulation thrombus was detected with computed tomography angiography and blood pressure was measured prior to intravenous thrombolytic therapy in 104 patients. Baseline clinical and imaging information were collected. Group comparisons were performed; Collateral Score (CS) was assessed and entered into logistic regression analysis. Results: Fifty-eight patients out of 104 displayed good collateral filling (CS ≥2). Poor CS was associated with more severe strokes according to National Institutes of Health Stroke Scale (NIHSS) at arrival (16 vs. 11, p = 0.005) and at 24 h (15 vs. 3, p < 0.001) after the treatment. Good CS was associated with higher systolic blood pressure (p = 0.03), but not with diastolic blood pressure (p = 0.26), pulse pressure (p = 0.20) or mean arterial pressure (p = 0.07). Good CS was associated with better Alberta Stroke Program Early CT Score (ASPECTS) in 24 h follow-up imaging (p < 0.001) and favorable clinical outcome at three months (mRS ≤2, p < 0.001). Median CS was the highest (CS = 3) when systolic blood pressure was between 170 and 190 mm Hg (p = 0.03). There was no significant difference in the number of patients with good (n = 11) and poor (n = 12) CS who received intravenous antihypertensive medication (p = 0.39) before or during the thrombolytic therapy. In multivariate analysis age (p = 0.02, OR 0.957 per year, 95% CI 0.92-0.99), time from the onset of symptoms to treatment (p = 0.005, OR 1.03 per minute, 95% CI 1.01-1.05), distal clot location (p = 0.02, OR 3.52, 95% CI 1.19-10.35) and systolic blood pressure (p = 0.04, OR 1.03 per unit mm Hg, 95% CI 1.00-1.05) predicted good CS. Higher systolic blood pressure (p = 0.049, OR 0.96 per unit mm Hg, 95% CI 0.93-1.00) and pulse pressure (p = 0.005, OR 0.94 per unit mm Hg, 95% CI 0.90-0.98) predicted unfavorable clinical outcome at three months in multivariate analysis. Conclusion: Moderately elevated systolic blood pressure is associated with good collateral circulation in patients treated with intravenous thrombolytic therapy. However, there is an inverse association of systolic blood pressure with the three-month clinical outcome. Diastolic blood pressure, mean arterial pressure and pulse pressure are not statistically and significantly associated with collateral status.

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