Abstract
BackgroundElevated blood pressure is frequently seen in acute stroke, and patients with lacunar and nonlacunar infarcts may have different underlying mechanisms for increase in blood pressure. The impact of hypertension as a risk factor may also vary. The aims of the present study were to investigate blood pressure in patients presenting with lacunar syndromes but with different anatomical subtypes of stroke, to explore the impact of subtype on blood pressure, and to identify stroke-related factors associated with hypertension.MethodsConsecutive patients presenting with an acute lacunar syndrome were enrolled. Patients were classified into a lacunar or nonlacunar group based on radiological verified infarcts. Blood pressure was measured. Between-group differences were analyzed by χ2-test, t-test, and Mann–Whitney U test, as appropriate. We performed linear regression to analyze the association between blood pressure and lacunar infarct, and multiple linear regression to adjust for other covariates.ResultsOne hundred thirteen patients were included. Seventy five percent had lacunar and 25% nonlacunar infarcts. There was no significant difference in clinical severity between the two groups. In the linear regression model, we found a significant association between blood pressure and lacunar infarct. No other factor was significantly associated with blood pressure in the two groups.ConclusionsLacunar infarcts may be independently associated with higher blood pressure compared to nonlacunar infarcts with the same clinical severity. Blood pressure differences between different subtypes of stroke may not be related to clinical severity but to the underlying cause of stroke.
Highlights
Ischemic stroke is anatomically differentiated in lacunar, cortical, and large subcortical infarcts
The nonlacunar infarcts were localized in the cortex or subcortically, but none were due to occlusion of a major vessel
Patients with acute lacunar infarcts had significantly higher blood pressure on day 3 compared to patients with acute non-lacunar infarcts, regardless of prestroke hypertension
Summary
Ischemic stroke is anatomically differentiated in lacunar, cortical, and large subcortical infarcts. It was thought that high blood pressure (BP) was strongly associated with lacunar infarct in particular (Fisher 1982; You et al 1995), but newer studies have shown that risk factors of lacunar stroke do not differ from other stroke subtypes (Boiten et al 1996; Jackson and Sudlow 2005). Brain and Behavior published by Wiley Periodicals, Inc. Elevated blood pressure is frequently seen in acute stroke, and patients with lacunar and nonlacunar infarcts may have different underlying mechanisms for increase in blood pressure. The aims of the present study were to investigate blood pressure in patients presenting with lacunar syndromes but with different anatomical subtypes of stroke, to explore the impact of subtype on blood pressure, and to identify stroke-related factors associated with hypertension. Blood pressure differences between different subtypes of stroke may not be related to clinical severity but to the underlying cause of stroke
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