Dataset Information

Abnormal orthostatic blood pressure control among subjects with lacunar infarction.

ABSTRACT:

Introduction

Hypertension is a recognised risk factor for lacunar stroke. However, their association has been evaluated using static blood pressure (BP) assessment in supine or sitting position alone. We hypothesised that impaired dynamic (orthostatic) BP control may associate with lacunar strokes.

Patients and methods

Consecutive subjects with mitral regurgitation (MR) confirmed, lacunar strokes were compared with two control groups. Firstly "normal", age and sex matched, population controls (1:3 ratio) and then 'at risk' controls matched for age, sex, hypertension history and antihypertensive medication (1:2 ratio). Orthostatic BP control was assessed by active stand tests with continuous, phasic, beat-to-beat BP measurement.

Findings

Thirty-six subjects (mean 69.9 years) were compared with 108 controls in group 1 and 72 in group 2. Prevalence of syncope was higher among those with lacunar stroke (cases: 44.4%, group 1: 17.6%, p?=?0.003, group 2: 12.5%, p?=?0.0004, Fisher's exact). Mean baseline systolic BP (SBP) was significantly higher in cases (cases: 150?mm Hg, group 1: 140?mm Hg, p?=?0.03, group 2: 143?mm Hg, p?=?0.1). Ten seconds after standing, SBP dropped significantly less in cases (cases: -14.1?mm Hg, group 1: -31.4?mm Hg, p?p?=?0.001, t test). Diastolic BP also fell significantly less in cases. Cases' SBP and DBP recovered to, then persistently overshot baseline levels.

Discussion and conclusion

Subjects with MR-defined lacunar stroke, of likely small vessel aetiology, exhibit orthostatic hypertension compared with population norms.

SUBMITTER: Ryan DJ

PROVIDER: S-EPMC6301241 | biostudies-literature | 2016 Sep

REPOSITORIES: biostudies-literature

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Publications

Abnormal orthostatic blood pressure control among subjects with lacunar infarction.

Ryan Daniel J DJ Kenny Rose Anne RA Finucane Ciaran C Meaney James F JF Collins Daniel R DR Walsh Suzanne S Harbison Joseph A JA

European stroke journal 20160804 3

<h4>Introduction</h4>Hypertension is a recognised risk factor for lacunar stroke. However, their association has been evaluated using static blood pressure (BP) assessment in supine or sitting position alone. We hypothesised that impaired dynamic (orthostatic) BP control may associate with lacunar strokes.<h4>Patients and methods</h4>Consecutive subjects with mitral regurgitation (MR) confirmed, lacunar strokes were compared with two control groups. Firstly "normal", age and sex matched, populat ...[more]

PMID: 31008283

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Project description:IntroductionExtracellular volume (ECV) predicts mortality in hemodialysis patients, but it is difficult to assess clinically. Peridialytic blood pressure (BP) measurements can help ECV assessment. Orthostatic BP is routinely measured clinically, but its association with ECV is unknown.MethodsIn a cohort of hypertensive hemodialysis patients, we measured posthemodialysis ECV/weight with bioimpedance spectroscopy and analyzed its association with post-HD orthostatic BP measurements obtained during routine care. Using linear and logistic regression, the primary outcomes were orthostatic BP change and orthostatic hypotension (OH) defined by systolic BP decrease of at least 20 mmHg or diastolic decrease of at least 10 mmHg. Model 1 controlled for sex, age, and diabetes. Model 2 additionally controlled for ultrafiltration rate and antihypertensive medications. We conducted sensitivity analysis using OH definition of systolic BP decrease of at least 30 mmHg.FindingsAmong 57 participants, mean orthostatic systolic BP change was -7.30 (20) mmHg and mean ECV/weight was 0.24 (0.04) L/kg. Post-HD ECV/weight was not associated with orthostatic systolic BP change (β = 8.2, p = 0.6). There were 16 participants with and 41 participants without OH. The ECV/weight did not differ between these groups (0.22 [0.04] vs. 0.24 [0.05] L/Kg, p = 0.09) and did not predict OH in logistic regression (OR 11, 4.04; 95% CI 0.2-671, 0.03-0.530 in the two models.) In a sensitivity analysis, ECV/weight was lower in the OH group (0.22 [0.03] vs. 0.25 [0.04] L/kg, p = 0.005), but this was accompanied by differences in sex and diabetes. Using logistic regression, there was no independent association between ECV/weight with OH.DiscussionOrthostatic systolic BP change after HD completion is not a reliable indicator of posthemodialysis ECV. When considering other factors associated with orthostatic BP, ECV/weight is not independently associated with OH. Although transient postdialytic differences in intravascular volume may be associated with OH, posthemodialysis OH does not necessarily indicate ECV depletion.

Dataset Information

Abnormal orthostatic blood pressure control among subjects with lacunar infarction.

Introduction

Patients and methods

Findings

Discussion and conclusion

Publications

Abnormal orthostatic blood pressure control among subjects with lacunar infarction.

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