Presentation on theme: "G.N. Dalekos3, M. Elisaf2, A.I. Hatzitolios1"— Presentation transcript:
2G.N. Dalekos3, M. Elisaf2, A.I. Hatzitolios1 ASSOCIATION OF CIRCADIAN BLOOD PRESSURE AND HEART RATE PATTERNS WITH SEVERITY OF ACUTE ISCHEMIC STROKE: PRELIMINARY RESULTSN. Kakaletsis1, H. Milionis2, G. Ntaios3, C. Savopoulos1, K. Makaritsis3, K. Tziomalos1,G.N. Dalekos3, M. Elisaf2, A.I. Hatzitolios1First Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, GreeceDepartment of Medicine, University of Ioannina, Ioannina, GreeceDepartment of Medicine, University of Thessaly, Larissa, GreeceLARISSA 21 March 2015
3Introduction - AimThe association of blood pressure (BP) levels following acute ischemic stroke (AIS) with outcome still remains controversial.BP is increased in up to 75% to 80% of patients with acute stroke and usually decreases spontaneously over the next few days. 1-3Data from a number of studies suggest that high BP in the acute stroke period is associated with a poor short-term outcome, but in other studies the opposite has been reported. 4-7Recently, ambulatory 24-hour BP monitoring (ABPM) which allows the more precisely observation of a rapidly evolving phenomenon such as the BP course in the acute stage of stroke, has been used.Our purpose is to study the relationship between BP course in the acute phase of stroke by ambulatory 24-hour BP monitoring (ABPM) and stroke severity assessed with the National Institutes of Health Stroke Scale (NIHSS).1. Wallace et al, JAMA Britton et al, Stroke Toyoda et al, Stroke Lawes et al, Stroke Robinson et al, Cerebrovasc Dis Allen et al, J Neurol Neurosurg Psychiatry Jorgensen et al, Lancet 1994
4Methods Inclusion Criteria: Exclusion Criteria: Known stroke risk factors and clinical findings on admission were recorded.ABPM every 20 min within 24 hours of hospital admissionautomated oscillometric device (TM 2430, A&D Company Ltd)Day-time; 7:00-22:59Night-time; 23:00-6:59Definitions;Minor AIS: NIHSS ≤4Moderate/severe AIS: NIHSS>4Analysis of parameters derived by ABPM was made by BP analysis software;Doctor Pro 3 (A&D Company Ltd)Statistical analysis for continuous data (mean ± standard deviation) was made by Student's T-test, while for non-continuous data (numbers and percentages) chi-square test was used.IBM SPSS Statistics for Windows, Version 21.0Blood Pressure Variability in Acute Ischemic Stroke (PREVISE study) NCTInclusion Criteria:Acute ischemic strokeAdmission within 24 after the onset of symptomExclusion Criteria:Transient ischemic attackIntracerebral hemorrhageSubarachnoid hemorrhageCerebral sinus venous thrombosisStroke mimicsLate admission (>24 hours after stroke onset)The protocol has been approved by Bioethics Committee of Medical School of Aristotle University of Thessaloniki and local University Hospital Scientific Committees
5Clinical characteristics and known stroke risk factors on admission VariablesPopulation (n=22)NIHSS≤4(n=9)NIHSS>4 (n=13)pPre-Stroke mRS>218 (81.8%)7 (77.8%)11 (84.6%)1.000NIHSS admission9.9 (9.1)2.3 (1.1)15.2 (8,5)<0.001Age (years)79.3 (7)77.8 (5.6)80.4 (7.9)0.404Male gender12 (54.5%)6 (66.7%)6 (46.2%)0.342Cerebrovascular Disease6 (27.3%)3 (33.3%)3 (23.1%)0.595Hypertension19 (86.4%)8 (88.9%)Dyslipidemia15 (68.2%)8 (61.5%)0.421Diabetes Mellitus8 (36.4%)2 (22.2%)0.251Atrial Fibrillation1 (11.1%)7 (53.8%)0.040SmokingCoronary artery Disease5 (22.7%)4 (30.8%)0.279Congestive Heart Failure3 (13.6%)0 (0%)0.240Body Mass Index29.4 (5.1)29.6 (5)29.4 (5.3)0.927Statistical analysis for continuous data (mean ± standard deviation) was made by Student’s T-test, while for non-continuous data (numbers and percentages) chi-square test was used.
6Parameters derived by 24-h ABPM VariablesPopulation (n=22)NIHSS≤4(n=9)NIHSS>4 (n=13)pSystolic24h SBP147.7 (17.7)143.8 (14)149.6 (20)0.460Mean day SBP147.4 (16.9)144,8 (14.7)149.2 (18.7)0.557Mean night SBP146.5 (22.2)140 (16.8)150.9 (24.9)0.266p (day/night)0.7150.2840.607-Diastolic24h DBP77.4 (11)74.1 (11.7)79.7 (11.7)0.251Mean day DBP78.1 (11)75.2 (9.9)80.2 (11.6)0.313Mean night DBP75.1 (11.8)70.1 (8.8)78.6 (12.6)0.0970.0330.0090.438Mean24h MBP100.3 (12.7)96.9 (10.5)102.7 (13.9)0.303Mean day MBP100.9 (12.5)98 (11.3)102.8 (13.4)0.386Mean night MBP98.6 (14.6)93.1 (10.8)102.5 (16)0.1420.1590.0600.849Heart Rate24h HR72.7 (13.7)63.9 (6.8)79.1 (13.9)0.003Mean day HR73.2 (12.6)65.4 (6.9)78.5 (13)0.006Mean night HR72.7 (17.4)60.2 (7.5)81.3 (17.1)0.0010.7710.250SBP: Systolic BP (mmHg), DBP: Diastolic BP (mmHg), MBP: Mean BP = DBP + Pulse Pressure/3 (mmHg), HR: Heart rate (bpm)ConclusionsLower values of DBP (dipping pattern) and HR during night in AIS patients derived by ABPM are associated with minor AIS.Furthermore, higher HR values during 24h are associated with moderate/severe AIS.