FUNCTIONAL RECOVERY IN PATIENTS WITH ACUTE ISCHEMIC STROKE AND ITS DEPENDENCE ON THE BLOOD PRESSURE VARIABILITY

T. M. Cherenko; Yu.L.  Heletyuk

doi:10.32345/USMYJ.1(105).2018.11-16

T. M. Cherenko Bogomolets National Medical University, Kyiv, Ukraine
Yu.L. Heletyuk Bogomolets National Medical University, Kyiv, Ukraine

DOI: https://doi.org/10.32345/USMYJ.1(105).2018.11-16

Keywords: acute ischemic stroke, Barthel index, arterial hypertension, blood pressure variability

Abstract

Objective - to investigate the association between functional recovery in patients with acute ischemic stroke and arterial hypertension, daily blood pressure (BP) monitoring and its variability.

Materials and methods. One hundred fifty patients with initial ischemic stroke and history of arterial hypertension have been examined: 74 (49.3%) women and 76 (50.7%) men with mean age of 67.4±0.7 years. Neurological deficit was evaluated by NIHSS scale, functional outcome – by Barthel index. The diagnosis of hypertension was based on the results of clinical, instrumental examination and medical documentation. Blood pressure daily monitoring was applied from the admission and every 4 hours during 6 days of acute stroke period. We studied mean values of SBP, DBP, maximum values of SBP and DBP, the variability of blood pressure (SD), counted for SBP and DBP. Statistical analysis of the results was performed using the statistical analysis IBM SPSS Statistics Base v.22.

Results. The degree of functional recovery in patients with history of hypertension in the acute stroke period significantly correlated with the severity of hypertension (r=0.351), its duration (r=0.426) and degree of neurological deficiency at discharge: r=0.739, p=0.001.

The most significant association between the parameters of daily blood pressure monitoring and functional dependence at the end of an acute period was established: between SD SBP and the Barthel index for 1 day, 1-3 days and 1-6 days: r =-0427, r =-0.551 and r =-0.515, respectively; SD DBP significantly correlated only in the interval from 1 to 3 days (r=0,550). Single-factor regression analysis has found the association between the functional defect degree in patientswith acute stroke at discharge and systolic blood pressure variability over a period of 1-3 days, R2 = 0.304.

Conclusions. The effectiveness of functional recovery depends on the systolic blood pressure variability over a period of 1-3 days after stroke.

References

Артеріальна гіпертензія оновлена та адаптована клінічна настанова, заснована на доказах (2012 рік) // Артериальная гипер тензия- 2012,- № 1 (21) (hup: www.mif-ua.com archive article 26383).

Артеріальна гіпертензія. Уніфікований клінічний протокол первинної, екстреної та вторинної (спеціалізованої) медичної допо моги 2012 //Новости медицины и фармации,- 2012,-№ И (421). URL: (http://www. mif-ua. com/archive/article/31084).

Бююлъ А., Цефелъ П. SPSS: искусство обработки информа ции. Анализ статистических данных и восстановление скрытых за кономерностей //ДиаСофт - 2005 - 608 с.

Черенъко Т.М., Гелетюк Ю.Л. Роль показників добового моні- торування артеріального тиску та його варіабельності у прогнозу ванні наслідків гострого ішемічного інсульту. Український неврологі чний журнал, №1, 2018, с. 13-20.

Bangalore S. et al. Blood pressure and in-hospital outcomes in patients presenting with ischaemic stroke. European Heart Journal (2017) 0, 1-9. doi: 10.1093/eurheartj/ehx330.

Buratti L., Cagnetti С., Balucani C., Viticchi G., Falsetti L., Luzzi S. et al. Blood pressure variability and stroke outcome in patients with internal carotid artery occlusion. J Neurol Sci. 2014;339:164-168. doi: 10.1016/j.jns.2014.02.007.

de Havenon A., Bennett A., Stoddard G.J., Smith G., Chung L., O’Donnell S., McNally J.S., Tirschwell D., Majersik J.J. Determinants of the impact of blood pressure variability on neurological outcome after acute ischaemic stroke. Stroke Vase Neurol. 2017 Feb 24;2(1): 1-6.

de Havenon A., Bennett A., Stoddard G.J., Smith G., Wang H, Wold J., Chung L., Tirschwell L.D., Majersik J.J. Increased Blood Pressure Variability Is Associated with Worse Neurologic Outcome in Acute Anterior Circulation Ischemic Stroke. Stroke Research and Treatment. Volume 2016, Article ID 7670161, 8 pages http://dx.doi.org/10.1155/2016/7670161.

Fukuda K, Kai H, Kamouchi M., Hata J., Ago T, Nakane H, Imaizumi T, Kitazono T; FSR Investigators; steering committee of the Fukuoka Stroke Registry included. Day-by-Day Blood Pressure Variability and Functional Outcome After Acute Ischemic Stroke: Fukuoka Stroke Registry. Stroke. 2015;46 (7): 1832-1839.

Jira M. et al. Association of eNOS gene polymorphisms T-786C and G894T with blood pressure variability in man. Physiol. Res. 60, 193- 197 (2011).

Kang J., Ko K, Park J. H, Kim W.J., Jang M.S., YangM.H, Lee J., Lee J., Han M.K, Gorelick P.B., Bae H.J. Effect of blood pressure on 3- month functional outcome in the subacute stage of ischemic stroke. Neurology. 2012; 79(20) :2018-24.

Lisa S. Manning, Peter M. Rothwell, John F. Potter, Thompson G. Robinson. Prognostic Significance of Short-Term Blood Pressure Variability in Acute Stroke Systematic Review. Stroke. 2015;46:2482-2490.Madden KP, Karanjia PN, Adams HP Jr, Clarke WR. Accuracy of initial stroke subtype diagnosis in the TOAST study. Trial of ORG 10172 in Acute Stroke Treatment. Neurology.- 1995.- №11. — C. 75-79.

Mahoney F.I., Barthel D.W. Functional evaluation: The Barthel index//Md. State. Med. J.- 1965.- Vol. 14.- P. 61—65.

Mei Yong, Markku Paste. Association of Characteristics of Blood Pressure Profiles and Stroke Outcomes in the ECASS-II Trial. Stroke. 2008;39:366-372

Milonas D., Tziomalos K. Blood Pressure Variability: Does it predict the outcome of acute ischemic stroke? American Journal of Hypertension, Volume 30, Issue 5, 1 May 2017, Pages 476—477, https:// doi.org/10.1093/ajh/hpx019, Bangalore S., Schwamm L., Smith E. E., Hellkamp A. S., Suter R. E., Xian Y., Schulte Ph. J., Fonarow G. C, and BhattD. L., for the Get With the Guidelines-Stroke Steering Committee and Investigators. Blood pressure and in-hospital outcomes in patients presenting with ischaemic stroke. European Heart Journal (2017) 0, 1—9. doi: 10.1093/eurheartj/ehx330.

Odderson IR. The National Institutes of Health Stroke Scale and its importance in acute stroke management. Phys Med Rehabil Clin N Am. 1999: 10(4): 787-800.

Ogedegbe G, Pickering T. Principles and techniques of blood pressure measurement. Cardiol Clin. 2010 Nov; 28(4): 571—586. doi: 10.1016/j. ccl. 2010.07.006.

Parati G, Ochoa JE, Lombardi C, Bilo G. Assessment and management of blood-pressure variability. Nat Rev Cardiol. 2013;10:143— 155. doi: 10.1038/nrcardio.2013.1.

Tziomalos K, Giampatzis V, Bouziana SD, Spanou M, Kostaki S, Papadopoulou M, Angelopoulou SM, Tsopozidi M, Savopoulos C, Hatzitolios Al. No association observed between blood pressure variability during the acute phase of ischemic stroke and in-hospital out-comes. Am J Hypertens 2016; 29:841-846.

WheltonP.K., CareyR.M., AronowW.S, CaseyD.E. Jr.,

Collins K.J., Dennison Himmelfarb C., De Palma S.M., GiddingS., JamersonK.A., JonesD.W., MacLaughlinE.J., MuntnerP, OvbiageleB., Smith S.C. Jr., Spencer C.C., Stafford P.S., Taler S.J., Thomas R.J., Williams KA. Sr., Williamson J.D., Wright J.T. Jr. 2017АСС/АНА/ААРА/ ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines [published online ahead of print November 13, 2017]. Hypertension, doi: 10.1161/

HYP. 0000000000000065.