(Stroke. 1997;28:1671-1676.)
© 1997 American Heart Association, Inc.
Articles |
Cardiac Baroreceptor Sensitivity Is Impaired After Acute Stroke
From the University Division of Medicine for the Elderly, The Glenfield Hospital, and the University Division of Medical Physics, Leicester Royal Infirmary (R.P.), Leicester, UK.
Correspondence to Dr T.G. Robinson, Department of Medicine, Leicester General Hospital, Gwendolen Rd, Leicester LE5 4PW, UK.
Background and Purpose The blood pressure (BP) fall and increased BP variability after acute stroke have been previously described. The underlying pathophysiological mechanisms producing these findings are unclear but may include abnormalities of cardiac baroreceptor reflex arc and/or changes in sympathetic nervous system activity. To date, evidence of impaired cardiac baroreceptor sensitivity (BRS) after stroke is limited to patients with chronic disease as determined by invasive methodology. Therefore, it was proposed to assess cardiac BRS and sympathovagal balance with the use of novel noninvasive techniques after acute stroke.
Methods Thirty-seven acute stroke patients underwent simultaneous surface electrocardiographic and noninvasive beat-to-beat BP recording. Cardiac BRS was assessed by power spectral analysis techniques, and sympathovagal balance was determined from the ratio of the low- to high-frequency powers for pulse interval variability. The responses were compared with a control group matched for age, sex, and BP.
Results Median cardiac BRS was significantly lower in
stroke patients than in control subjects (high-frequency 
-index,
4.89 versus 6.50 ms/mm Hg; P=.007; combined -index, 4.65
versus 5.46 ms/mm Hg; P=.02). Median normalized high- but
not low-frequency power of systolic BP variability was
significantly greater in stroke patients (11.0 versus 6.7 normalized
units; P<.001), probably reflecting differences in the
mechanical effects of respiration on BP in stroke patients. No
significant differences were observed in the power spectrum of pulse
interval variability between stroke patients and control subjects.
Patients with right hemisphere strokes, however, had a significant
reduction in median high-frequency pulse interval power compared with
patients with left hemisphere strokes (8 versus 20 normalized units;
P=.03), which may reflect a change in sympathovagal balance
in favor of increased sympathetic tone in this group.
Conclusions The impairment of cardiac BRS may be important in explaining the increased BP variability after stroke. There was no significant difference in surrogate measures of sympathovagal activity between acute stroke patients and control subjects, but right hemisphere stroke patients had a significant alteration in the sympathovagal balance of pulse interval variability compared with left hemisphere stroke patients. This sympathetic predominance in right hemisphere strokes may be important in the development of cardiac arrhythmias after stroke. The prognostic implications of these findings need to be further explored.
Key Words: baroreflex • blood pressure • stroke, acute
This article has been cited by other articles:
 |
|
 |
|
  A. I. Qureshi Acute Hypertensive Response in Patients With Stroke: Pathophysiology and Management Circulation, July 8, 2008; 118(2): 176 - 187. [Full Text] [PDF]
|
|
|
|
 |
|
 A.-J. Liu, X.-J. Ma, F.-M. Shen, J.-G. Liu, H. Chen, and D.-F. Su Arterial Baroreflex: A Novel Target for Preventing Stroke in Rat Hypertension Stroke, June 1, 2007; 38(6): 1916 - 1923. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Chamorro, X. Urra, and A. M. Planas Infection After Acute Ischemic Stroke: A Manifestation of Brain-Induced Immunodepression Stroke, March 1, 2007; 38(3): 1097 - 1103. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. G. Stead, R. M. Gilmore, K. C. Vedula, A. L. Weaver, W. W. Decker, and R. D. Brown Jr Impact of acute blood pressure variability on ischemic stroke outcome Neurology, June 27, 2006; 66(12): 1878 - 1881. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Nasr, A. Pavy-Le Traon, and V. Larrue Baroreflex Sensitivity Is Impaired in Bilateral Carotid Atherosclerosis Stroke, September 1, 2005; 36(9): 1891 - 1895. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Avnon, M. Nitzan, E. Sprecher, Z. Rogowski, and D. Yarnitsky Autonomic asymmetry in migraine: augmented parasympathetic activation in left unilateral migraineurs Brain, September 1, 2004; 127(9): 2099 - 2108. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. J. Carey, R. B. Panerai, and J. F. Potter Effect of Aging on Dynamic Cerebral Autoregulation During Head-Up Tilt Stroke, August 1, 2003; 34(8): 1871 - 1875. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. G. Robinson, S. L. Dawson, P. J. Eames, R. B. Panerai, J. F. Potter, and S. Oppenheimer Cardiac Baroreceptor Sensitivity Predicts Long-Term Outcome After Acute Ischemic Stroke * Editorial Comment Stroke, March 1, 2003; 34(3): 705 - 712. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P J Eames, M J Blake, S L Dawson, R B Panerai, and J F Potter Dynamic cerebral autoregulation and beat to beat blood pressure control are impaired in acute ischaemic stroke J. Neurol. Neurosurg. Psychiatry, April 1, 2002; 72(4): 467 - 472. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. M. Saleh, A. E. Cribb, and B. J. Connell Reduction in infarct size by local estrogen does not prevent autonomic dysfunction after stroke Am J Physiol Regulatory Integrative Comp Physiol, December 1, 2001; 281(6): R2088 - R2095. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. M. Saleh, A. E. Cribb, and B. J. Connell Estrogen-induced recovery of autonomic function after middle cerebral artery occlusion in male rats Am J Physiol Regulatory Integrative Comp Physiol, November 1, 2001; 281(5): R1531 - R1539. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. J. Carey, P. J. Eames, M. J. Blake, R. B. Panerai, and J. F. Potter Dynamic Cerebral Autoregulation Is Unaffected by Aging Stroke, December 1, 2000; 31(12): 2895 - 2900. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M. Phillips, D. L. Jardine, P. J. Parkin, T. Hughes, H. Ikram, and H. Ikram Brain Stem Stroke Causing Baroreflex Failure and Paroxysmal Hypertension Stroke, August 1, 2000; 31(8): 1997 - 2001. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. L. Dawson, B. N. Manktelow, T. G. Robinson, R. B. Panerai, and J. F. Potter Which Parameters of Beat-to-Beat Blood Pressure and Variability Best Predict Early Outcome After Acute Ischemic Stroke? Stroke, February 1, 2000; 31(2): 463 - 468. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Robinson, J. Potter, R. Panerai, J. T. Korpelainen, K. A. Sotaniemi, and V. V. Myllyla Heart Rate Variability Following Ischemic Stroke • Response Stroke, October 1, 1999; 30 (10): 2238a - 2248. [Full Text] [PDF]
|
|
|
|
 |
|
 J.F. Potter What should we do about blood pressure and stroke? QJM, February 1, 1999; 92(2): 63 - 66. [Full Text] [PDF]
|
|
|
|
|
|
T. Robinson and J. Potter Cardiopulmonary and Arterial Baroreflex-Mediated Control of Forearm Vasomotor Tone Is Impaired After Acute Stroke Stroke, December 1, 1997; 28(12): 2357 - 2362. [Abstract] [Full Text]
|
|