The Effect of Circadian Blood Pressure in The Development of Lacunar Infarcts, Together with Other Possible Factors

Year 2022, Volume: 8 Issue: 1, 9 - 13, 31.03.2022

Gökhan Keskin Abdulkadir Çakmak

https://doi.org/10.22399/ijcesen.1076178

Abstract

This study was carried out in Amasya University S.S.R.E. Hospital Department of Neurology and Cardiology between 2021 and 2022. Total number of 58 patients (29 lacunar infarct patients and 29 control subjects, 42 females and 16 males) over the age of 45 (mean age 57.1+-6.8) were recruited to the study. All patients underwent 24-hour blood pressure monitoring. The patients with a history of stroke, malignancy, renal or endocrinal disease were excluded from the study. According to the systolic blood pressure measurements, twenty-seven patients were ‘non-Dipper’ and thirty-one patients were ‘Dipper’. Diastolic blood pressure measurements revealed that twenty-one patients were ‘non-Dipper’ and thirty-seven patients were ‘Dipper’.Mean daytime and night-time systolic blood pressure values were higher in patients with lacunar infarction (p:0.02). There was no difference in the diastolic BP and variability (p > 0,05). The clinical importance of the alteration in the reduction of blood pressure is still controversial. Understanding the alterations in blood pressure rhythmicity will be helpful to prevent and treat the lacunar infarctions.

Keywords

Blood pressure, Lacunar Infarct, Circadian

References

• [1] Donnan G, Norrving B, Bamford J, Bogousslavsky J, eds. (2002). Subcortical stroke. 2nd edn. Oxford: Oxford Medical Publications
• [2]Lammie GA (2000). Pathology of small vessel stroke. Br Med Bull 56(2):296–306. DOI: 10.1258/0007142001903229
• [3] Fisher CM. (1982). Lacunar strokes and infarcts: a review. Neurology. 32(8):871-876. DOI: 10.1212/wnl.32.8.871.
• [4] Shimada K, Kawamoto A, Matsubayashi K, Ozawa T. (1990). Silent cerebrovascular disease in the elderly: correlation with ambulatory pressure. Hypertension. 16(6): 692- 699. DOI: 10.1161/01.HYP.16.6.692
• [5] Kobayashi S, Okada K, Yamashita K. (1991). Incidence of silent lacunar lesion in normal adults and its relation to cerebral blood flow and risk factors. Stroke. 221:379-383. DOI: 10.1161/01.STR.22.11.1379
• [6] Lodder J, Boiten J. (1993). Incidence, natural history, and risk factors in lacunar infarction. Adv Neurol. 62: 213- 227.
• [7] Verdecchia P. (2000). Prognostic value of ambulatory blood pressure. Hypertension. 35(3): 844–851. DOI: 10.1161/01.HYP.35.3.844
• [8] Kukla C, Sander D, Schwarze J, Wittich I, Klingelhöfer J. (1998). Changes of circadian Blood Pressure Patterns Are Associated With the Occurrence of Lacunar Infarction. Arch Neurol. 55(5): 683-688. DOI:10.1001/archneur.55.5.683
• [9] Yamamoto Y., I. Akiguchi, K. Oiwa, M. Hayashi, T. Kasai, K. Ozasa. (2002). Twenty-four Hour Blood Pressure and MRI as Predictive Factors for Different Outcomes in Patients With Lacunar Infarct. Stroke. 33(1): 297-305. DOI: 10.1161/str.33.1.297
• [10]Verdecchia P. (2000). Prognostic value of ambulatory blood pressure. Hypertension. 35(3): 844–851. DOI: 10.1161/01.HYP.35.3.844
• [11] Mohr JP, Marti-Vilalta JL. Lacunes. In: Barnett HJM, Mohr JP, Stein BM, yatsu FM, eds.(1998) Stroke. Pathophysiology, diagnosis, and management. 3rd ed. Philadelphia, PA: Churchill-Livingstone; 599-622.
• [12] Arboix A., C. Morcillo, L. Garcı́a-Eroles et al. (2000). Different vascular risk factor profiles in ischemic stroke subtypesa study from the “Sagrat Cor Hospital of Barcelona Stroke Registry.” Acta Neurol Scand. 102(4): 264–270. DOI: 10.1034/j.1600-0404.2000.102004264.x
• [13] Watanabe N, Imai Y, Nagai K, Tsuji I, Satoh H, Sakuma M, et al. (1996). Nocturnal blood pressure and silent cerebrovascular lesions in elderly Japanese. Stroke. 27(8): 1319-1327. DOI: 10.1161/01.STR.27.8.1319
• [14] Sander D, Klingelhöfer J. (1996). Diurnal systolic blood pressure variability is the strongest predictor of early carotid atherosclerosis. Neurology. 47(2): 500-507. DOI: 10.1212/WNL.47.2.500
• [15] Sander D, Kukla C, Klingelhöfer J, Winbeck K, Conrad B. (2000). Relationship between circadian blood pressure patterns and progression of early carotid atherosclerosis: A 3-year follow-up study. Circulation. 102(13): 1536-1541. DOI: 10.1161/01.CIR.102.13.1536
• [16] Cupini LM, Pasqualetti P, Diomedi M, Vernieri F, Silvestrini M, Rizzato B. et al..(2002). Carotid artery intima-media thickness and lacunar versus nonlacunar infarcts. Stroke. 33(3): 689-694. DOI: 10.1161/hs0302.103661
• [17] Polonia J, Amado P, Barbosa L, Nazare J, Silva JA. Bertoquini S. et al., (2005). Morning rise, morning surge and daytime variability of blood pressure and cardiovascular target organ damage. A cross-sectional study in 743 subjects. Rev Port Cardiol. 24(1): 65-78. PMID: 15773667.
• [18] Yamamoto Y, Akiguchi I, Oiwa K, Masamichi H, Kimura J. (1998). Adverse Effect of Nighttime Blood Pressure on the Outcome of Lacunar Infarct Patients. Stroke. 29(3): 570-576. DOI: 10.1161/01.STR.29.3.570
• [19] Yamamoto Y, Akiguchi I, Oiwa K, Satoi H, Kimura J. (1995). Diminished nocturnal blood pressure decline and lesion site in cerebrovascular disease. Stroke. 26(5): 829 – 833. DOI: 10.1161/01.str.26.5.829
• [20] Dawson SL, Evans SN, Manktelow BN, Fotherby MD, Robinson TG, Potter JF. Diurnal (1998). Blood Pressure Change Varies with Stroke Subtype in the Acute Phase. Stroke. 29(8): 1519-1524. DOI: 10.1161/01.STR.29.8.1519
• [21] Nakamura K, Oita J, Yamaguchi T. (1995). Nocturnal Blood Pressure Dip in Stroke Survivors. A Pilot Study. Stroke. 26(8): 1373-1378. DOI: 10.1161/01.str.26.8.1373
• [22] Johnston JH, Beevers DG, Dunn FG, Larkin H, Titterington DM. (1981). The importance of good blood pressure control in the prevention of stroke recurrence in hypertensive patients. Postgrad Med J. 57: 690-693. DOI: 10.1136/pgmj.57.673.690
• [23] Meyer JS, Rogers RL, Mortel KF. (1985). Prospective analysis of long-term control of mild hypertension on cerebral blood flow. Stroke. 16(6): 985-990. DOI: 10.1161/01.STR.16.6.985
• [24] Kario K, Motai K, Mitsuhashi T, Suzuki T, Nakagawa Y, Ikeda U, Matsuo T, Nakayama T, Shimada K. (1997). Autonomic nervous system dysfunction in elderly hypertensive patients with abnormal diurnal blood pressure variation: relation to silent cerebrovascular disease. Hypertension. 30(6): 1504-1510. DOI: 10.1161/01.HYP.30.6.1504