Ischemic Stroke In Hypertensive Patients Research Articles

Identification of Serum Biomarkers of Ischemic Stroke in a Hypertensive Population Based on Metabolomics and Lipidomics.

Hypertensive individuals are at a high risk of stroke, and thus, prevention of stroke in hypertensive patients is essential. Metabolomics and lipidomics can be used to identify diagnostic biomarkers and conduct early assessments of stroke risk in hypertensive populations. In this study, serum samples were collected from 30 hypertensive ischemic stroke (IS), 30 matched hypertensive and 30 matched healthy participants. Metabolomics and lipidomics analyses were conducted via liquid chromatography-tandem mass spectrometry, and the data were analyzed using multivariate and univariate statistical methods. A random forest algorithm and binary logistic regression were used to screen the biomarkers and establish diagnostic model. We detected 21 differential metabolites and 38 differential lipids between the hypertensive IS and healthy group. Moreover, we found 18 differential metabolites and 31 differential lipids between the hypertensive IS and hypertension group. In particular, the following seven metabolites or lipids distinguished the hypertensive IS from the healthy group: 4-hydroxyphenylpyruvic acid, cafestol, phosphatidylethanolamine (PE) (18:0p/18:2), PE (16:0e/20:4), (O-acyI)-1-hydroxy fatty acid (36:3), PE (16:0p/20:3) and PE (18:1p/18:2) (rep). The following seven biomarkers distinguished the hypertensive IS from the hypertension group: diglyceride (DG) (20:1/18:2), PE (18:0p/18:2), PE (16:0e/22:5), phosphatidylcholine (40:7), dimethylphosphatidylethanolamine (50:3), DG (18:1/18:2), and 4-hydroxyphenylpyruvic acid. The aforementioned panels had good diagnostic and predictive ability for hypertensive IS. Our study determines the metabolomic and lipidomic profiles of hypertensive IS patients and thereby identifies potential biomarkers of the presence of IS in hypertensive populations.

Interpretable machine learning for predicting 28-day all-cause in-hospital mortality for hypertensive ischemic or hemorrhagic stroke patients in the ICU: a multi-center retrospective cohort study with internal and external cross-validation.

Timely and accurate outcome prediction plays a critical role in guiding clinical decisions for hypertensive ischemic or hemorrhagic stroke patients admitted to the ICU. However, interpreting and translating the predictive models into clinical applications are as important as the prediction itself. This study aimed to develop an interpretable machine learning (IML) model that accurately predicts 28-day all-cause mortality in hypertensive ischemic or hemorrhagic stroke patients. A total of 4,274 hypertensive ischemic or hemorrhagic stroke patients admitted to the ICU in the USA from multicenter cohorts were included in this study to develop and validate the IML model. Five machine learning (ML) models were developed, including artificial neural network (ANN), gradient boosting machine (GBM), eXtreme Gradient Boosting (XGBoost), logistic regression (LR), and support vector machine (SVM), to predict mortality using the MIMIC-IV and eICU-CRD database in the USA. Feature selection was performed using the Least Absolute Shrinkage and Selection Operator (LASSO) algorithm. Model performance was evaluated based on the area under the curve (AUC), accuracy, positive predictive value (PPV), and negative predictive value (NPV). The ML model with the best predictive performance was selected for interpretability analysis. Finally, the SHapley Additive exPlanations (SHAP) method was employed to evaluate the risk of all-cause in-hospital mortality among hypertensive ischemic or hemorrhagic stroke patients admitted to the ICU. The XGBoost model demonstrated the best predictive performance, with the AUC values of 0.822, 0.739, and 0.700 in the training, test, and external cohorts, respectively. The analysis of feature importance revealed that age, ethnicity, white blood cell (WBC), hyperlipidemia, mean corpuscular volume (MCV), glucose, pulse oximeter oxygen saturation (SpO2), serum calcium, red blood cell distribution width (RDW), blood urea nitrogen (BUN), and bicarbonate were the 11 most important features. The SHAP plots were employed to interpret the XGBoost model. The XGBoost model accurately predicted 28-day all-cause in-hospital mortality among hypertensive ischemic or hemorrhagic stroke patients admitted to the ICU. The SHAP method can provide explicit explanations of personalized risk prediction, which can aid physicians in understanding the model.

PS-C02-8: ROLE OF STATIN THERAPY IN HYPERTENSION, PLEIOTROPIC EFFECT IN REDUCING NEW-ONSET AF AND ISCHEMIC STROKE

Introduction: Hypertension is considered the most important risk factor for stroke in the general population, is the most common comorbidity in patients with atrial fibrillation (AF), and is prevalent in approximately 80 to 90% of subjects with AF enrolled in recent clinical trials. Statin drugs have potent anti inflammatory and antioxidant effects that have the potential to prevent AF. Patients who had ischemic stroke complications due to episodes of AF are usually asymptomatic, thus primary prevention of AF in hypertensive patients is very important. Objectives: To determine the effectiveness of statin in reducing the incidence of new onset AF and ischemic stroke complications in hypertensive patients. Methods: We included 180 subjects in this retrospective cohort study using medical records at Sanglah General Hospital from 2018 to 2020. Subjects were divided into hypertensive subjects who were treated with a statin and hypertensive subjects who were not given statins, and we tracked the incidence of new onset AF. Pearson chi square test was used to determine the association of baseline characteristics, comorbidities, and medications, including statin, on the outcome of new onset AF, ischemic stroke, and side effects of statin. The progression of new onset AF between groups was also compared with the Kaplan Meier curve. Results: Our subjects who used statin were 39.4%, the mean age for all was 51.51+12.31 with 28,3% new onset AF, 7,2% ischemic stroke, and 2.2% all cause death. Statin in hypertensive patients significantly reduced the incidence of new onset AF (PR 0.174; 95%CI 0.079–0.38; P < 0.001) with a longer AF free period (19.16 + 2.57 vs 13.68 + 0.67 months; 95%CI 5.01–5.84; P = 0.014) and ischemic stroke free period (23.72 + 0.71 vs 16.57 + 1.06 month; 95%CI 5.01–5.84; P = 0.003), without any significant relationship with the adverse effect of statin. The incidence of AF was significantly high in hypertensive subjects with comorbid heart failure (HF) however, the AF free period remains longer if hypertensive patients with HF are given statin (19.16 + 2.57 vs 13.68 + 0.67 month; 95%CI 5.01–5.84; P = 0.014). Conclusion: Statin administration has the potential to be an effective treatment for primary prevention of the incidence of new onset AF and ischemic stroke in hypertensive patients without significant side effects.

Association between Plasma Homocysteine Concentrations and the First Ischemic Stroke in Hypertensive Patients with Obstructive Sleep Apnea: A 7-Year Retrospective Cohort Study from China.

Purpose This study was aimed at investigating the association between baseline plasma homocysteine (Hcy) concentrations and the risk of the first ischemic stroke (IS) and at investigating any possible influential modifying factors in hypertensive patients with obstructive sleep apnea (OSA). Methods Cox proportional hazards regression was employed to investigate the relationship between plasma Hcy concentration and the first IS. A generalized additive model was applied to determine the nonlinear relationship. In addition, we conducted subgroup analysis. Results A total of 2350 hypertensive patients with OSA without a history of IS were enrolled in this study. At a median follow-up of 7.15 years, we identified 93 cases of the first IS. After adjusting for potential confounding, the findings revealed that plasma Hcy concentration was strongly and positively associated with the occurrence of the first IS (per SD increment; HR = 1.37, 95% CI: 1.30-1.44). A nonlinear relationship was found between plasma Hcy concentration and the risk of developing the first IS with inflection points for plasma Hcy of 5 μmol/L. In stratified analysis, a greater positive correlation was found between baseline plasma Hcy concentrations and new-onset IS in patients with DBP ≥ 90 mmHg (per SD increment; HR = 1.48, 95% CI: 1.33-1.65 vs. <90 mmHg: HR = 1.20, 95% CI: 1.02-1.42; P‐interaction = 0.04) and BMI ≥ 24 and <28 kg/m2 (per SD increment; HR = 1.46, 95% CI: 1.26-1.70 vs. <24 kg/m2: HR = 1.13, 95% CI: 0.95-1.33 vs. ≥28 kg/m2: HR = 1.46, 95% CI: 1.25-1.70; P‐interaction = 0.03). Conclusion Elevated plasma Hcy concentrations are independently associated with the risk of the first IS in hypertensive patients with OSA. Plasma Hcy concentrations ≥ 5 μmol/L surely increased the risk of the first IS in hypertensive patients with OSA.

The association of blood lipid parameters variability with ischemic stroke in hypertensive patients

Background and aimsThe relationship between lipid variability and stroke among patients with hypertension were inconclusive. We aimed to investigate the association of lipid variability with ischemic stroke in hypertensive patients. Methods and resultsThis retrospective cohort study included 4995 individuals with hypertension between 2013 and 2015, and recorded their status of ischemic stroke until the end of 2018. The variability in total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) were measured using the standard deviation (SD), coefficient of variation (CV), variability independent of the mean (VIM) and average absolute difference between successive values (ASV). Multivariate Cox proportional hazards models with hazard ratios (HRs) and 95% confidence interval (CI) were performed. There were 110 cases of ischemic stroke during a median follow up of 4.2 years. The multivariable adjusted HRs and 95% CIs comparing the highest versus the lowest quartiles of SD of TC, LDL-C, HDL-C and TG were 4.429 (95% CI: 2.292, 8.560), 2.140 (95% CI: 1.264, 3.621), 1.368 (95% CI: 0.793, 2.359) and 1.421 (95% CI: 0.800, 2.525), respectively. High variability in TC and LDL-C were associated with a higher risk for ischemic stroke. Similarly, the results were consistent when calculating variability of TC and LDL-C using CV, ASV and VIM, and in various subgroup analyses. ConclusionHigher variability of TC and LDL-C associated with the risk of ischemic stroke among hypertensive patients. These findings suggest reducing variability of lipid parameters may decrease adverse outcomes.

Observational study of the prevalence of non-valvular atrial fibrillation and ischemic stroke and the factors associated with non-valvular atrial fibrillation in hypertensive patients: about 2887 cases

RésuméIntroductionl´hypertension artérielle (HTA), la fibrillation auriculaire (FA) et l´accident vasculaire cérébral (AVC) sont trois problèmes de santé publique. A travers cette étude nous avons cherché à déterminer la prévalence de la FA et de l´AVC ischémique chez les patients hypertendus et déterminer les facteurs associés à la survenue de la FA non valvulaire chez ces patients.Méthodesnous avons utilisé les données recueillies dans le service de cardiologie de l´hôpital universitaire de Sfax dans le cadre du registre national tunisien d´HTA. Nous avons étudié les associations entre les différentes variables sociodémographiques, cliniques, paracliniques et thérapeutiques et la FA chez les hypertendus en utilisant des modèles de régression logistique.Résultatsnotre échantillon comprenait 2887 patients avec un sexe ratio à 0,95. L´âge moyen était de 65 ans (±11). La FA était notée chez 230 patients (8%), alors que l´AVC ischémique chez 152 patients (5,3%). Au décours de l´analyse multivariée, les facteurs indépendants associés à une augmentation de la prévalence de la FA étaient: l´âge avancé (p=0,001, Odds Ratio(OR) = 1,647, Intervalle de confiance (IC) à 95%: 1,1227-2,213), la présence d´une hypertrophie ventriculaire gauche (HVG) à l´échographie cardiaque(p = 0,004, OR = 2,140, IC95%: 1,281-3,576), et la fraction d´éjection du ventricule gauche (FEVG) < 50% (p < 0,001, OR = 4,677, IC95%: 2,715-8,057).Conclusionnous avons confirmé qu´il existe une relation directe et indépendante entre l´HTA, l´âge avancé, l´HVG et la FA. L´installation d´une FA au cours de l´HTA constitue un tournant évolutif de la maladie par majoration du risque d´AVC ischémique. Un contrôle optimal de la pression artérielle tensionnelle être hautement prioritaire chez les hypertendus, en particulier âgés, afin de prévenir le risque de la FA et de l´AVC.

Relationship between risk perception and lifestyle in ischemic stroke patients with H-type hypertension.

Patients with ischemic stroke who have H-type hypertension are at an increased risk of recurrent stroke. The relationship between risk perception and lifestyle in these patients has not been fully explored. The objective of this study is to investigate risk perceptions and lifestyles among H-type hypertensive ischemic stroke patients and explore their relationships. A total of 314 hypertensive ischemic stroke patients were divided according to homocysteine (Hcy) level into the normal Hcy and high Hcy group using convenience sampling. The high Hcy group was further divided into the perceived or non-perceived group based on the patients' risk perceptions. The Essen Stroke Risk Score and the Health Behavior Scale were used to investigate the patients' risk perceptions and lifestyles. The perceived risk factors in the high Hcy group included hypertension, diabetes, alcohol consumption, hyperlipidemia, and smoking, which showed no significant difference with those in the normal Hcy group. The high Hcy group had a total lifestyle score of (2.54±0.42). The perceived group had a better lifestyle than the non-perceived group; however, only blood pressure monitoring compliance showed a significant difference between the groups (P<0.05). The lifestyles of subjects whose perceived risks included diabetes, hyperlipidemia, smoking, and alcohol consumption were not significantly different to those in the non-perceived group. Patients with H-type hypertensive ischemic stroke who perceive hypertension as a risk factor have relatively good lifestyles. Therefore, efforts should be made to strengthen risk education for these patients to help improve their risk perception and lifestyles.

Factors influencing health behaviour, blood pressure control, and disability in hypertensive ischaemic stroke patients after a comprehensive reminder intervention.

To test prospective pathways of a Comprehensive Reminder System based on the Health Belief Model (CRS-HBM), stroke knowledge, health belief in health behaviour, blood pressure (BP) control, and disability in hypertensive ischaemic stroke patients at 6-month postdischarge. A nested cohort study design. Data were derived from a randomized controlled trial evaluating the effects of the intervention (N=174, performed during February 2015 - March 2016). Data were collected by questionnaires and analysed in structural equation modelling in Mplus software. The proposed model provided a good fit to the data. This model accounted for 51.5% of the variance in health behaviour, 34.1% in BP control, and 5.7% in modified Rankin Scale score at 6-month postdischarge. The CRS-HBM had: (a) direct positive effect (β=.391, p<.001) and indirect positive effects (β=.186, p=.002) on health behaviour; (b) direct positive effect (β=.356, p<.001) and indirect positive effects (β=.183, p=.009) on BP control; and (c) indirect negative effect (β=-.146, p=.008) on disability. Being female was linked to better health behaviour. Higher education predicted higher level of stroke knowledge and health belief. The CRS-HBM can not only directly but also indirectly improve patients' health behaviours by improving their health knowledge or health belief. Better health behaviour can improve patients' BP control and reduce disability. Therefore, nurses need to pay more attention to not only patients' health knowledge but also their health belief when providing education. The CRS-HBM intervention accounted for 51.5% of variance in health behaviour, 34.1% in BP control, and 5.7% in modified Rankin Scale score at 6-month postdischarge. This research can help nurses improve health education strategies in postdischarge and community contexts to achieve better health results.

Correlation of ACE Gene Polymorphism and Hypertension in Stroke Ischemic Patients

Stroke is the third highest cerebrovascular disease in the world with high mortality and disability rate that is mostly dominated by ischemic stroke. Genetic factor that had been reported to have an indirect effect in increasing the incidence of ischemic stroke is ACE gene polymorphism. ACE gene polymorphism is characterized by the insertion marked by letter (I) or deletion marked by letter (D) on intron 16, chromosome 17. ACE gene polymorphism has drawn a lot of attention from scientists and had been reported to have an indirect effect in increasing the ischemic stroke incidence through pathogenesis of hypertension and atherosclerosis. In this study, 78 subjects of ischemic stroke consist of 43 subjects with hypertension and 35 subjects with normotension. I allele of ACE gene polymorphism was more dominant than D allele in hypertensive ischemic stroke patients (72.1% &gt; 27,9%) and this dominance was also seen in the incidence of hypertension vs normotension (55.4% &gt; 44.6%). However, the correlation of ACE gene polymorphism with the incidence of hypertension was not statistically significant when compared based on its genotype (p=0.280) and allele (p=0.948).

Pioglitazone and PPAR-\u03b3 modulating treatment in hypertensive and type 2 diabetic patients after ischemic stroke: a national cohort study

Background and aimPeroxisome proliferator-activated receptor-γ (PPAR-γ) modulating treatment may have cardiovascular benefits in type 2 diabetes mellitus (T2DM) patients after ischemic stroke (IS). However, whether there are additional benefits from intensive PPAR-γ modulating treatments in Asian patients with T2DM and hypertension (HTN) after IS remains unknown.MethodsBetween 2001 and 2013, patients admitted due to IS were identified from the National Health Insurance Research Database of Taiwan. Patients with T2DM and HTN using angiotensin receptor blockers were further included. Eligible patients were divided into two groups: (1) pioglitazone and (2) non-pioglitazone oral anti-diabetic agent groups. Propensity score matching (1:2) was used to balance the distribution of baseline characteristics, stroke severity and medications. The primary outcome was recurrent IS. Subgroup analysis for recurrent IS in pioglitazone and/or telmisartan users, the trend of IS risks across different PPAR-γ intensity treatments, and dose-dependent outcomes across different pioglitazone possession ratios were further studied. Statistical significance was set at p < 0.05 and p < 0.1 for clinical outcomes and interaction of subgroup analyses, respectively.ResultsThere were 3190 and 32,645 patients in the pioglitazone and non-pioglitazone groups. Patients of the pioglitazone group had a lower risk of recurrent IS (subdistribution hazard ratio, 0.91; 95% confidence interval 0.84–0.99). Pioglitazone was also associated with reduced recurrent IS in patients who also used telmisartan (p for interaction = 0.071). A graded correlation was found a borderline significant trend between the intensity of PPAR-γ therapy and following IS (p = 0.076). The dose-dependent outcome also showed that a borderline significant trend that higher pioglitazone possession ratio was associated with a lower risk of recurrent IS (p = 0.068).ConclusionsThe current study suggests that the use of pioglitazone in type 2 diabetic and hypertensive IS patients is associated with fewer recurrent IS events in an Asian population. Concurrent telmisartan use or a higher pioglitazone possession ratio may have a trend of increased pleiotropic effects, which could possibly be related to higher PPAR-γ effects. Future studies are warranted to confirm or refute the clinical effects and the possible mechanism of more intensive PPAR-γ-modulating treatments.

A U-shaped association between serum betaine and incident risk of first ischemic stroke in hypertensive patients.

Betaine (a micronutrient) has important biological functions (e.g., preventing premature apoptosis and serving as a methyl donor). We investigated the association between baseline serum betaine and the incident risk of first stroke in hypertensive patients. We conducted a nested case-control study, including 622 patients with first stroke (including 502 ischemic stroke, 118 hemorrhagic stroke and 2 uncertain type of stroke) and 622 matched controls from the China Stroke Primary Prevention Trial (CSPPT). The study was conducted from May 2008 to August 2013. The study outcomes included first stroke and its subtypes: first ischemic and hemorrhagic stroke. There was a U-shaped association between baseline serum betaine and the risk of first ischemic stroke. The risk of first ischemic stroke decreased with the increment of betaine (per 10μmol/L increase: OR, 0.87; 95%CI: 0.77-0.99) in patients with betaine <77.7μmol/L, while the risk of first ischemic stroke increased with the betaine increment (OR, 1.17; 95%CI: 1.01-1.36) in patients with betaine ≥77.7μmol/L. However, there was no significant association between serum betaine and risk of first hemorrhagic stroke (per 10μmol/L increase: OR, 0.98; 95%CI: 0.82-1.17). There was a U-shaped association between baseline betaine levels and the risk of first ischemic stroke in hypertensive patients, with a turning point at about 77.7μmol/L. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00794885.

Qualitative research on the perceptions of hypertensive ischemic stroke patients with low medication adherence

Objective To explore the of hypertensive patients' uncontrolled blood pressure before onset of ischemic stroke so as to provide clinical evidence for stroke prevention. Methods The phenomenological analysis method in qualitative research was applied. From February to June 2016, 15 hypertensive ischemic stroke patients with hypertensive cerebral infarction and low medication adherence admitted to the department of neurology of three tertiary hospitals in Guangdong province were selected and participated in qualitative interviews. Results By Colaizzi phenomenological analysis method, the medication misconception of patients were summarized into 4 themes: estimating physical condition by self-feeling, holding the opinion that there was few relation between whether monitoring blood pressure, forgetting medication, stopping medication because of various reasons and cerebral infarction. Conclusions There are some misunderstandings in the cognition of taking medicine before the onset of hypertensive cerebral infarction. It suggests that we should strengthen blood pressure monitoring and health education of drug compliance in hypertensive patients and hypertensive cerebral infarction patients, so as to improve the effect of primary prevention and secondary prevention of stroke. Key words: Hypertension; Cerebral infarction; Medication adherence; Qualitative research

Metabolic Profile for Prediction of Ischemic Stroke in Chinese Hypertensive Population

BackgroundStroke burden is extremely high in Chinese hypertensive population. Novel biomarkers for cardiovascular diseases can be detected by metabolomic profiling of human fluids. We aim to find a panel of distinctive plasma metabolites for predicting incident ischemic stroke in hypertensive patients. MethodsThis is a nested case-control study from a prospective cohort design. Baseline plasma samples were collected from 66 newly developed ischemic stroke cases and 66 matched controls. Untargeted metabolomics was performed by ultra-high performance liquid chromatography-tandem mass spectrometry, and data were analyzed by multivariate and univariate statistics. ResultsPlasma metabolite profiles clearly differed between hypertensive patients with incident ischemic stroke and without. A total of 12 metabolites were screened and identified as potential biomarkers. The altered metabolic pathways included retinol metabolism, sphingolipid metabolism, glycerophospholipid metabolism, lysine degradation, tyrosine metabolism, and tryptophan metabolism. For prediction of hypertensive ischemic stroke, the panel of specific metabolomics-based biomarkers provided area under the curve of 0.848 (95% confidence interval: 0.783-0.913). ConclusionsOur study identified a metabolic signature of incident ischemic stroke in hypertension. Differences in small-molecule metabolites hold translational value in prediction and provide insights into potential new mechanisms of this condition.

The Efficacy of a Comprehensive Reminder System to Improve Health Behaviors and Blood Pressure Control in Hypertensive Ischemic Stroke Patients: A Randomized Controlled Trial.

The health behaviors of hypertensive stroke patients in China are not satisfactory. In this study, we tested the effect of a Health Belief Model Comprehensive Reminder System on health behaviors and blood pressure control in hypertensive ischemic stroke patients after occurrence and hospital discharge. A randomized, parallel-group, assessor-blinded experimental design yielded participation of 174 hospitalized hypertensive ischemic stroke patients. The intervention consisted of face-to-face and telephone health belief education, a patient calendar handbook, and weekly automated short-message services. Data were collected at baseline and 3 months after discharge. Three months after discharge, the intervention group showed statistically, significantly better health behaviors for physical activity, nutrition, low-salt diet, and medication adherence. The intervention group also had statistically, significantly decreased systolic blood pressure and increased blood pressure control rate. Smoking and alcohol use behaviors were not affected. At 3 months, use of the Comprehensive Reminder System based on the Health Belief Model, yielded improvement in most health behaviors and blood pressure control in hypertensive ischemic stroke patients. Continued implementation of this intervention protocol is warranted to determine the long-term effect. Smoking and alcohol use behaviors need to be targeted with a different intervention.

CIRCULATING ENDOTHELIAL CELLS AND ENDOTHELIAL PROGENITOR CELLS AS A MARKER OF ENDOTHELIAL DYSFUNCTION IN HYPERTENSIVE PATIENTS SURVIVED AFTER ISCHEMIC STROKE (REVIEW)

The main causes of ischemic stroke (IS) include arterial hypertension (HTN) and cerebral atherosclerosis. Based on the recent evidence, vascular endothelium is considered a target organ in patients with HTN and atherosclerosis, as well as an effector in their pathogenesis. The concept of endothelial dysfunction includes structural and functional changes in the endothelium. The level of circulating endothelial cells (CECs) and endothelial progenitor cells (EPCs) in the blood allows us to judge about degree of endothelial damage and its reparative activity. The article presents data on the diagnostic value of assessment of CECs and EPCs by flow cytometry for predicting the course and outcomes of IS in hypertensive patients.

Coronary tortuosity is associated with an elevated high-sensitivity C-reactive protein concentration and increased risk of ischemic stroke in hypertensive patients.

ObjectiveThe clinical implication of coronary tortuosity is unclear. The present study was conducted to determine the relationships between coronary tortuosity and the high-sensitivity C-reactive protein (hs-CRP) concentration and between coronary tortuosity and cerebrovascular accident in hypertensive patients without coronary artery disease.MethodsIn total, 236 patients with normal coronary angiography findings were categorized into 3 different groups: control participants (n = 58), who had neither hypertension nor coronary tortuosity; patients with hypertension but no coronary tortuosity (H-NCT group, n = 93); and patients with both hypertension and coronary tortuosity (H-CT group, n = 85). The hs-CRP concentration was measured in every patient, and 168 hypertensive patients were followed up for at least 2 years to check for the development of cerebrovascular accident.ResultsThe hs-CRP concentration was significantly higher in the H-CT group than in the control and H-NCT groups (4.33 ± 3.15 vs. 1.52 ± 1.31 and 2.31 ± 2.09 mg/L, respectively). The incidence of lacunar infarction was higher in the H-CT than H-NCT group during the follow-up.ConclusionsHypertensive patients with coronary tortuosity have a higher serum hs-CRP level concentration and have a higher incidence of lacunar infarction than hypertensive patients without coronary tortuosity.

Risk factors of ischemic stroke in hypertensive patients

Отсутствие специфических прогностических факторов повышенного риска развития инсульта и, как следствие, недостаток терапевтических подходов, направленных на его снижение, обусловливает необходимость поиска независимых предикторов цереброваскулярных осложнений у больных гипертонической болезнью (ГБ). Цель работы – определить предикторы риска развития ишемического инсульта среди показателей суточного мониторирования артериального давления, показателей вариабельности ритма сердца и аденозиндифосфат-индуцированной агрегации тромбоцитов у больных гипертонической болезнью. Материалы и методы. В исследование включено 88 больных. Пациентов разделили на две группы. Первую группу составили 39 больных, у которых течение ГБ осложнилось полушарным ишемическим инсультом, вторую группу − 49 больных ГБ, достигших целевого уровня АД на фоне лечения. Всем больным выполнено суточное мониторирование артериального давления (СМАД), суточное определение вариабельности ритма сердца (ВРС) и исследование агрегации тромбоцитов с аденозин 5'-дифосфатом в конечной концентрации индуктора агрегации 10,0 × 10 -6 моль/л. Для определения предикторов риска развития ишемического полушарного инсульта использовали метод логистического регрессионного анализа. Результаты. Группы больных были сопоставимы по возрасту (63 ± 9,1 против 64 ± 11,0 года; р = 0,682), однако различались по полу (мужчины составили 64 %, против 39 %; р = 0,018 соответственно). Повышение риска возникновения ишемического полушарного инсульта ассоциируется с показателями СМАД (средним CАД за день >132 мм рт. ст.; средним ДАД за ночь >70 мм рт. ст.; пульсовым АД за сутки >60 мм рт. ст., за день >58,6 мм рт. ст.; за ночь >57,9 мм рт. ст., индекс измерений САД за сутки >44,7 % и ДАД за сутки >37,7 %; индексом времени ДАД за ночь >62,6 %; индексом площади гипертензии САД за сутки >94,3 мм рт. ст. × ч и ДАД за сутки >58,4 мм рт. ст. × ч; AASI в сутки >0,52; средним гемодинамическим АД за сутки >94,8 мм рт. ст. и за ночь >87,1 мм рт. ст.; вариабельностью ПАД за день >11,8 мм рт. ст. и за ночь >8,2 мм рт. ст.; индексом «двойное произведение» >86,3 мм рт. ст. × уд/мин). Также с показателями ВРС (SDNN за сутки ≤91 мc и за день ≤83 мc; SDANN за сутки ≤99 мc и за день ≤76 мc; VLF за день ≤63,7 %; LF за день >27,1 %; индексом централизации >0,56), а также с показателем агрегации тромбоцитов (степенью максимальной АДФ-индуцированной агрегации тромбоцитов >65,2 %). При построении модели независимыми факторами риска ишемического полушарного инсульта у больных ГБ определяется SDNN за день (ОШ = 56,6; р = 0,011), индекс измерений СAТ за сутки (ОШ = 40,9; р = 0,033), среднее САД за день (ОШ = 30,0; р = 0,021), а также вариабельность ПАД за ночь (ОШ = 15,1; р = 0,043). Выводы . Независимыми факторами риска ишемического полушарного инсульта у больных гипертонической болезнью является SDNN за день, индекс измерений СAД за сутки, среднее САД за день, вариабельность ПАД за ночь. Степень АДФ-индуцированной агрегации тромбоцитов более 65,2 % является зависимым фактором риска, который увеличивает отношение шансов ишемического инсульта в 6,5 раза (р = 0,007).

Role of Brain Biomarker in Predicting Clinical Outcome in Hypertensive Cerebrovascular Ischemic Stroke.

This study was undertaken to evaluate the role of serum neuron specific enolase (NSE) in prediction of disability and neurological worsening in hypertensive ischemic cerebrovascular stroke. 80 hypertensive ischemic stroke patients diagnosed by a neurologist as per WHO definition along with radiological findings suggestive of cerebrovascular stroke and differentiating from hemorrhagic stroke and 60 controls having essential hypertension coming to hospital because of regular checkup or headache but with no neurological disease were included in the study. Neurological disability was assessed by NIHSS at the time of admission (within 72h from the onset of stroke) and on 7th day after admission and cases were categorized into mild, moderate and severe disability. Venous blood samples were drawn within 72h from the onset of symptoms. The samples were processed as per the laboratory protocol. The serum NSE samples were analyzed using an enzyme immunoassay based on the sandwich technique. We observed raised serum NSE in hypertensive ischemic stroke (17.4±5.4ng/ml) with significant association between different hypertensive groups than in hypertensive controls (9.1±0.75ng/ml). Greater degree of disability was observed in hypertensive stroke patients with raised serum NSE and hypertensive patients with mean serum NSE level of 22.9±3.6ng/ml and dyslipidemia had greater probability of neurological worsening as compared to those with mean serum NSE level of 12.7±1.2ng/ml. Serum NSE levels can serve as a peripheral indicator of neuronal damage and assist in the prediction of disability and clinical outcome in hypertensive cerebrovascular ischemic stroke patients.

OS 32-04 ACUTE BLOOD PRESSURE CONTROL BY RENAL DENERVATION IMPROVED PROGNOSIS AFTER CEREBRAL INFARCTION THROUGH REDUCTION OF OXIDATIVE STRESS IN SHRSP RATS

Although hypertensive patients show significant elevation of blood pressure (BP) in acute phase after cerebral infarction, it is still unknown how it should be managed to carry the best prognosis. To address this issue, we investigated the effect of acute control of elevated BP by bilateral renal denervation (RD) against ischemic stroke in SHRSP rats with 90 minutes transient middle cerebral arterial occlusion (MCAO). Seventy-five male SHRSP rats of 15 weeks of age were assigned to sham-operated (control, n = 15) and MCAO + sham (sham, n = 30), and MCAO + RD (RD, n = 30). Bilateral RD was done approximately 30 minutes after ischemia induction. In experiment 1, we evaluated the acute effects of RD by measurement of continuous BP, cerebral blood flow (CBF), cerebral vascular resistance (CVR), vasoreactivity by acetazolamide, neurological function, and infarct volume. In addition, phosphorylated Akt and e-NOS, and oxidative stress using gp91phox and dihydroethidium in ischemic brain were also evaluated at 24 hours after ischemia induction. In experiment 2, temporal changes of body weight of the rats were measured in every week and also rotarod test were assessed around 4 weeks after ischemia induction. Although the ischemic rats in sham group showed severe hypertension, RD significantly reduced BP through 24 hours after ischemia induction. The value of CBF after reprefusion was significantly lower in RD group compared to sham group, while CVR and vasoreactivity was not changed by RD. RD significantly ameliorated neurological deficit and infarct volume. Moreover, RD reduced not only the level of phosphorylated Akt and e-NOS but also oxidative stress. In experiment 2, body weight and rotarod test showed significant increasing in RD group compared to sham group. Our results suggest that acute blood pressure control by RD is promising therapeutic strategy to improve prognosis after ischemic stroke in hypertensive patients.

Autonomic symptoms in hypertensive patients with post-acute minor ischemic stroke

BackgroundMost studies regarding autonomic dysfunction in ischemic stroke are limited to heart rate and blood pressure changes during the acute phase. However, there are few data on quantitative assessment of autonomic symptoms. We sought to assess autonomic symptoms in hypertensive ischemic stroke patients. MethodsIn 100 hypertensive patients (45 with symptomatic ischemic stroke (6 months after stroke onset) and 55 without stroke), we assessed autonomic symptoms using the Scale for Outcomes in Parkinson disease-Autonomic (SCOPA-AUT). ResultsThe age (mean±standard deviation) for the stroke group was 66±12 and 63±15 for the without stroke group (P=0.8). Orthostatic hypotension occurred in 3.6% of the stroke group and 4.4% in the group without stroke. The total SCOPA-AUT score was higher in the stroke group compared with the group without stroke (P=0.001). Domain scores for gastrointestinal (P=0.001), urinary (P=0.005) and cardiovascular (P=0.001) were higher in the stroke group. No differences were found when comparing the total SCOPA-AUT scores for stroke subtypes (P=0.168) and for lateralization (P=0.6). SCOPA AUT scores were correlated with depression scores (P=0.001) but not with stroke severity (P=0.2). ConclusionAutonomic symptoms, especially, gastrointestinal, urinary and cardiovascular function, were significantly increased in hypertensive patients with minor ischemic stroke. Symptoms were associated with depression but not with the characteristic of the stroke.