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A stress-related explanation to the increased blood pressure and its course following ischemic stroke

BACKGROUND: A hypertensive response after ischemic stroke is frequent, yet its pathophysiology is unknown. Mechanisms related to local ischemic damage, major vascular occlusion, and psychological stress due to acute illness have been proposed. We assessed the natural course of blood pressure (BP) wi...

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Autores principales: Kvistad, Christopher Elnan, Oygarden, Halvor, Logallo, Nicola, Thomassen, Lars, Waje-Andreassen, Ulrike, Moen, Gunnar, Naess, Halvor
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5113932/
https://www.ncbi.nlm.nih.gov/pubmed/27956837
http://dx.doi.org/10.2147/VHRM.S109032
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author Kvistad, Christopher Elnan
Oygarden, Halvor
Logallo, Nicola
Thomassen, Lars
Waje-Andreassen, Ulrike
Moen, Gunnar
Naess, Halvor
author_facet Kvistad, Christopher Elnan
Oygarden, Halvor
Logallo, Nicola
Thomassen, Lars
Waje-Andreassen, Ulrike
Moen, Gunnar
Naess, Halvor
author_sort Kvistad, Christopher Elnan
collection PubMed
description BACKGROUND: A hypertensive response after ischemic stroke is frequent, yet its pathophysiology is unknown. Mechanisms related to local ischemic damage, major vascular occlusion, and psychological stress due to acute illness have been proposed. We assessed the natural course of blood pressure (BP) within the first 24 h in groups of ischemic stroke patients with different characteristics. We hypothesized that a consistent BP reduction, regardless of stroke location, time window from debut to admission and presence of persistent vascular occlusion, would favor a stress-related mechanism as an important cause of the hypertensive response after ischemic stroke. METHODS: Ischemic stroke patients (n=1067) were prospectively registered, and BP was measured on admission and <3 h, 3–6 h, 6–12 h and 12–24 h after admission. Patients were categorized according to the location of diffusion-weighted imaging (DWI) lesions (cortical, large subcortical, mixed cortico-subcortical, lacunar, cerebellar, brain stem or multiple), time window (admitted within or after 6 h of symptom onset) and presence of persistent proximal middle cerebral artery (MCA) occlusion versus normal findings on magnetic resonance angiography (MRA) at 24 h. RESULTS: A reduction in systolic BP and diastolic BP from baseline to 12–24 h was found across all DWI locations except for diastolic BP in cerebellar (P=0.072) lesions. Apart from diastolic BP in patients with normal MRA findings at 24 h (P=0.060), a significant fall in systolic BP and diastolic BP at 12–24 h was registered, irrespective of whether patients were admitted within 6 h or after 6 h of stroke onset or had persistent MCA occlusion versus normal MRA findings. CONCLUSION: We found a relatively consistent decline in BP within 24 h after admission across different stroke locations in patients admitted within or after 6 h of stroke onset and in patients with persistent MCA occlusion. Our findings suggest that a systemic factor such as psychological stress may be an important contributor to the frequently elevated BP on admission in patients with ischemic stroke.
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spelling pubmed-51139322016-12-12 A stress-related explanation to the increased blood pressure and its course following ischemic stroke Kvistad, Christopher Elnan Oygarden, Halvor Logallo, Nicola Thomassen, Lars Waje-Andreassen, Ulrike Moen, Gunnar Naess, Halvor Vasc Health Risk Manag Original Research BACKGROUND: A hypertensive response after ischemic stroke is frequent, yet its pathophysiology is unknown. Mechanisms related to local ischemic damage, major vascular occlusion, and psychological stress due to acute illness have been proposed. We assessed the natural course of blood pressure (BP) within the first 24 h in groups of ischemic stroke patients with different characteristics. We hypothesized that a consistent BP reduction, regardless of stroke location, time window from debut to admission and presence of persistent vascular occlusion, would favor a stress-related mechanism as an important cause of the hypertensive response after ischemic stroke. METHODS: Ischemic stroke patients (n=1067) were prospectively registered, and BP was measured on admission and <3 h, 3–6 h, 6–12 h and 12–24 h after admission. Patients were categorized according to the location of diffusion-weighted imaging (DWI) lesions (cortical, large subcortical, mixed cortico-subcortical, lacunar, cerebellar, brain stem or multiple), time window (admitted within or after 6 h of symptom onset) and presence of persistent proximal middle cerebral artery (MCA) occlusion versus normal findings on magnetic resonance angiography (MRA) at 24 h. RESULTS: A reduction in systolic BP and diastolic BP from baseline to 12–24 h was found across all DWI locations except for diastolic BP in cerebellar (P=0.072) lesions. Apart from diastolic BP in patients with normal MRA findings at 24 h (P=0.060), a significant fall in systolic BP and diastolic BP at 12–24 h was registered, irrespective of whether patients were admitted within 6 h or after 6 h of stroke onset or had persistent MCA occlusion versus normal MRA findings. CONCLUSION: We found a relatively consistent decline in BP within 24 h after admission across different stroke locations in patients admitted within or after 6 h of stroke onset and in patients with persistent MCA occlusion. Our findings suggest that a systemic factor such as psychological stress may be an important contributor to the frequently elevated BP on admission in patients with ischemic stroke. Dove Medical Press 2016-11-11 /pmc/articles/PMC5113932/ /pubmed/27956837 http://dx.doi.org/10.2147/VHRM.S109032 Text en © 2016 Kvistad et al. This work is published and licensed by Dove Medical Press Limited The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
spellingShingle Original Research
Kvistad, Christopher Elnan
Oygarden, Halvor
Logallo, Nicola
Thomassen, Lars
Waje-Andreassen, Ulrike
Moen, Gunnar
Naess, Halvor
A stress-related explanation to the increased blood pressure and its course following ischemic stroke
title A stress-related explanation to the increased blood pressure and its course following ischemic stroke
title_full A stress-related explanation to the increased blood pressure and its course following ischemic stroke
title_fullStr A stress-related explanation to the increased blood pressure and its course following ischemic stroke
title_full_unstemmed A stress-related explanation to the increased blood pressure and its course following ischemic stroke
title_short A stress-related explanation to the increased blood pressure and its course following ischemic stroke
title_sort stress-related explanation to the increased blood pressure and its course following ischemic stroke
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5113932/
https://www.ncbi.nlm.nih.gov/pubmed/27956837
http://dx.doi.org/10.2147/VHRM.S109032
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