DIFFERENCES IN BIOMARKERS LEVELS AND BRACHIAL AND CENTRAL BLOOD PRESSURE DURING THE ACUTE PHASE OF STROKE BETWEEN LACUNAR AND OTHER ISCHEMIC STROKES SUBTYPES

Abstract

Objective: We aimed to evaluate the differences in biomarker levels and brachial and central blood pressure estimates during the acute and subacute phase of stroke, between lacunar infarcts and other ischemic stroke subtypes. Design and method: Patients > 18 years old, with a first episode of ischemic stroke, admitted to our institution between July 2015 and July 2017 were consecutively included. Subjects with Rankin > 2 and patients with history of previous heart failure were excluded. Blood pressure (BP) was measured at admission and during the acute phase of stroke. Determination of proBNP, urinary albumin excretion (UAE) and an echocardiographic study were performed in all subjects. The aortic pulse wave velocity (aPWV) and 24 h brachial and central BP (24h-ABPM) were measured by means of Mobil-O-Graph device during the subacute phase of stroke. Results: 71 subjects with a first episode of ischemic stroke were included, mean age: 64.7 ± 13.9 years, 62% men: 22 lacunar stroke (31%), and 49 cases (69%) with non lacunar ischemic stroke. The levels of proBNP were significantly lower in patients with lacunar stroke as compared as atherothrombotic and cardioembolic stroke (median: 36, 277 and 274 pg/mL, respectively; p = 0.009). After adjusting for age, patients with lacunar stroke had significantly higher levels of BP in the emergency department: systolic BP 173 ± 37 vs 153 ± 28 mm Hg respectively; p = 0.006, diastolic BP: 97 ± 21 vs 86 ± 16 mm Hg; p = 0.035, and during the acute phase of stroke: systolic BP 142 ± 19 vs 128 ± 16 mm Hg; p = 0.002; diastolic BP: 79 ± 12 and 73 ± 12 mm Hg respectively; p = 0.025. Regarding 24h-ABPM, patients with lacunar stroke showed higher values of daytime pulse pressure, daytime brachial systolic BP, daytime brachial diastolic BP and central BP estimates, after adjusting for age. No significant differences were observed in target organ damage between the different ischemic stroke subtypes. Conclusions: Patients with a first episode of lacunar stroke had lower levels of proBNP and higher BP levels during acute and subacute phase of stroke, suggesting a closer relationship with hypertension.