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(Stroke. 2005;36:1026.)
© 2005 American Heart Association, Inc.

Original Contributions

Autonomic Function Is Impaired in Elderly Stroke Survivors

Andrew McLaren, MRCP; Simon Kerr, MRCP; Louise Allan, MRCP; I. Nicholas Steen, PhD; Clive Ballard, MD, MRCPsych; John Allen, PhD; Alan Murray, PhD Rose Anne Kenny, MD, FRCP

From the Institute for Ageing and Health (A.M., S.K., L.A., R.A.K.), Newcastle General Hospital, Westgate Road, Newcastle upon Tyne; the Centre for Health Services Research (I.N.S.), School of Population and Health Sciences (Epidemiology and Public Health), University of Newcastle upon Tyne; the Wolfson Centre for Age Related Disorders (C.B.), Guy’s Campus, King’s College London; and the Regional Medical Physics Department (J.A., A.M.), Freeman Hospital, Newcastle upon Tyne.

Correspondence to Dr Andrew McLaren, Institute for Ageing and Health, Newcastle General Hospital, Westgate Road, Newcastle upon Tyne NE4 6BE. E-mail a.t.mclaren{at}ncl.ac.uk

Background and Purpose— Impaired autonomic function is common in the acute poststroke phase but little is known about the longer term effects, particularly in older people. We sought to determine if autonomic function is impaired after stroke recovery in older patients.

Methods— A cross-sectional case-control study comparing autonomic function in 76 nondemented stroke patients with 70 community-living controls aged older than 75 years.

Results— Cases were assessed on average 9 months after stroke. From power spectral analysis of heart rate variability, stroke patients had lower total (P=0.032) and low-frequency (P=0.014) spectral densities and impaired baroreflex sensitivity ( low-frequency baroreflex sensitivity, P=0.006). From a series of cardiovascular autonomic reflex tests, heart rate variation during forced respiration, Valsalva ratio, and blood pressure overshoot during Valsalva maneuver were significantly lower in stroke patients (P=0.003, <0.001, and 0.027, respectively). Blood pressure response to isometric exercise was significantly exaggerated in stroke patients (P=0.007).

Conclusions— Cardiovascular autonomic function is impaired long after the index event in stroke survivors. Impaired autonomic function may increase the risk of all-cause mortality and cardiovascular mortality in older stroke survivors.

Key Words: autonomic nervous system • stroke