Stroke, Vol 25, 1730-1737, Copyright © 1994 by American Heart Association
D Sander and J Klingelhofer
BACKGROUND AND PURPOSE: We investigated the changes of circadian blood
pressure patterns after thromboembolic and hemodynamic brain infarction and
evaluated the relation between circadian blood pressure variation, infarct
location, and activation of the autonomic nervous system after
thromboembolic stroke. METHODS: Repeated 24-hour blood pressure
measurements were performed in 45 patients with proven first-ever brain
infarctions of different origins. Evaluation of serum norepinephrine
concentration, prolongation of the QT interval, and degree of cardiac
arrhythmias were used to determine the extent of sympathetic activation
after thromboembolic stroke. RESULTS: Whereas circadian blood pressure
variation was significantly increased after hemodynamic infarction compared
with a control group (diastolic, -25.2 +/- 4.5% versus -13.8 +/- 6.5%; p
< .005), a clearly reduced variation was observed after thromboembolic
infarction (diastolic, -5.2 +/- 6.9%). Blood pressure variation was
positively related to serum norepinephrine concentration (r = .79; P <
.01) after thromboembolic infarction. Patients with involvement of the
insular cortex showed a nocturnal rise of blood pressure significantly more
frequently (66.7% versus 11.8%; P < .005) and had higher norepinephrine
levels (66.7 +/- 110 pg/mL versus 290 +/- 178 pg/mL; P < .01) than
patients without insular cortex infarction, indicating increased
sympathetic activity. This was associated with a significantly more
frequent occurrence of QT prolongation and cardiac arrhythmias.
CONCLUSIONS: The observed differences in circadian blood pressure patterns
may (1) help to distinguish the pathophysiological basis of the stroke, (2)
help to explain worsening in some cases of hemodynamic stroke, (3) confirm
the importance of the insular cortex for sympathetic activation, and (4)
identify subgroups of patients with increased risk of myocardial infarction
and arrhythmia.
ARTICLES
Changes of circadian blood pressure patterns after hemodynamic and thromboembolic brain infarction
Department of Neurology, Technical University of Munich, Germany.
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