Twenty-four-hour ambulatory blood pressure variability and association with ischemic stroke subtypes in the subacute stage
Background and purposeBlood pressure (BP) variability (BPV) increases the risk of cerebral disease in both hemorrhagic and ischemic strokes. However, whether BPV is associated with different types of ischemic stroke remains unclear. In this study, we explored the relationship between BPV and ischemi...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-04-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2023.1139816/full |
| _version_ | 1797845579064147968 |
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| author | Lijuan Wang Lijuan Wang Xiaoshuang Xia Xin Liu Guilin Wu Yanna Wang Dongliang Yang Peilin Liu Zhuangzhuang Chen Lin Wang Xin Li |
| author_facet | Lijuan Wang Lijuan Wang Xiaoshuang Xia Xin Liu Guilin Wu Yanna Wang Dongliang Yang Peilin Liu Zhuangzhuang Chen Lin Wang Xin Li |
| author_sort | Lijuan Wang |
| collection | DOAJ |
| description | Background and purposeBlood pressure (BP) variability (BPV) increases the risk of cerebral disease in both hemorrhagic and ischemic strokes. However, whether BPV is associated with different types of ischemic stroke remains unclear. In this study, we explored the relationship between BPV and ischemic stroke subtypes.MethodsWe enrolled consecutive patients aged 47–95 years with ischemic stroke in the subacute stage. We categorized them into four groups based on their artery atherosclerosis severity, brain magnetic resonance imaging markers, and disease history: large-artery atherosclerosis, branch atheromatous disease, small-vessel disease, and cardioembolic stroke. Twenty-four-hour ambulatory blood pressure monitoring was performed, and the mean systolic blood pressure/diastolic blood pressure, standard deviation, and coefficient of variation were calculated. A multiple logistic regression model and random forest were used to test the relationship between BP and BPV in the different types of ischemic stroke.ResultsA total of 286 patients, including 150 men (73.0 ± 12.3 years) and 136 women (77.8 ± 9.6 years) were included in the study. Of these, 86 (30.1%) patients had large-artery atherosclerosis, 76 (26.6%) had branch atheromatous disease, 82 (28.7%) had small-vessel disease, and 42 (14.7%) had cardioembolic stroke. There were statistically significant differences in BPV between subtypes of ischemic stroke in 24-h ambulatory blood pressure monitoring. The random forest model showed that BP and BPV were important features associated with ischemic stroke. Multinomial logistic regression analysis demonstrated that systolic blood pressure levels; systolic blood pressure variability at 24 h, daytime and nighttime; and nighttime diastolic blood pressure were independent risk factors for large-artery atherosclerosis after adjustment for confounders. When compared to branch atheromatous disease and small-vessel disease, nighttime diastolic blood pressure and standard deviation of diastolic blood pressure were significantly associated with patients in the cardioembolic stroke group. However, a similar statistical difference was not seen in patients with large-artery atherosclerosis.ConclusionThe results of this study indicate a discrepancy in blood pressure variability among different ischemic stroke subtypes during the subacute stage. Higher systolic blood pressure and systolic blood pressure variability during the 24 h, daytime, and nighttime, and nighttime diastolic blood pressure were independent predictors for large-artery atherosclerosis stroke. Increased nighttime diastolic BPV was an independent risk factor for cardioembolic stroke. |
| first_indexed | 2024-04-09T17:42:22Z |
| format | Article |
| id | doaj.art-ff4e9b1ca881461db5d1bfd63a751965 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-04-09T17:42:22Z |
| publishDate | 2023-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-ff4e9b1ca881461db5d1bfd63a7519652023-04-17T05:20:08ZengFrontiers Media S.A.Frontiers in Neurology1664-22952023-04-011410.3389/fneur.2023.11398161139816Twenty-four-hour ambulatory blood pressure variability and association with ischemic stroke subtypes in the subacute stageLijuan Wang0Lijuan Wang1Xiaoshuang Xia2Xin Liu3Guilin Wu4Yanna Wang5Dongliang Yang6Peilin Liu7Zhuangzhuang Chen8Lin Wang9Xin Li10Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, ChinaDepartment of Neurology, Beijing Zhongguancun Hospital, Beijing, ChinaDepartment of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, ChinaDepartment of Neurology, Beijing Zhongguancun Hospital, Beijing, ChinaBeijing Municipal Medical Insurance Bureau, Beijing, ChinaDepartment of Computer Teaching and Research Section, Cangzhou Medical College, Hebei, ChinaDepartment of Computer Teaching and Research Section, Cangzhou Medical College, Hebei, ChinaDepartment of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, ChinaDepartment of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, ChinaDepartment of Geriatrics, The Second Hospital of Tianjin Medical University, Tianjin, ChinaDepartment of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, ChinaBackground and purposeBlood pressure (BP) variability (BPV) increases the risk of cerebral disease in both hemorrhagic and ischemic strokes. However, whether BPV is associated with different types of ischemic stroke remains unclear. In this study, we explored the relationship between BPV and ischemic stroke subtypes.MethodsWe enrolled consecutive patients aged 47–95 years with ischemic stroke in the subacute stage. We categorized them into four groups based on their artery atherosclerosis severity, brain magnetic resonance imaging markers, and disease history: large-artery atherosclerosis, branch atheromatous disease, small-vessel disease, and cardioembolic stroke. Twenty-four-hour ambulatory blood pressure monitoring was performed, and the mean systolic blood pressure/diastolic blood pressure, standard deviation, and coefficient of variation were calculated. A multiple logistic regression model and random forest were used to test the relationship between BP and BPV in the different types of ischemic stroke.ResultsA total of 286 patients, including 150 men (73.0 ± 12.3 years) and 136 women (77.8 ± 9.6 years) were included in the study. Of these, 86 (30.1%) patients had large-artery atherosclerosis, 76 (26.6%) had branch atheromatous disease, 82 (28.7%) had small-vessel disease, and 42 (14.7%) had cardioembolic stroke. There were statistically significant differences in BPV between subtypes of ischemic stroke in 24-h ambulatory blood pressure monitoring. The random forest model showed that BP and BPV were important features associated with ischemic stroke. Multinomial logistic regression analysis demonstrated that systolic blood pressure levels; systolic blood pressure variability at 24 h, daytime and nighttime; and nighttime diastolic blood pressure were independent risk factors for large-artery atherosclerosis after adjustment for confounders. When compared to branch atheromatous disease and small-vessel disease, nighttime diastolic blood pressure and standard deviation of diastolic blood pressure were significantly associated with patients in the cardioembolic stroke group. However, a similar statistical difference was not seen in patients with large-artery atherosclerosis.ConclusionThe results of this study indicate a discrepancy in blood pressure variability among different ischemic stroke subtypes during the subacute stage. Higher systolic blood pressure and systolic blood pressure variability during the 24 h, daytime, and nighttime, and nighttime diastolic blood pressure were independent predictors for large-artery atherosclerosis stroke. Increased nighttime diastolic BPV was an independent risk factor for cardioembolic stroke.https://www.frontiersin.org/articles/10.3389/fneur.2023.1139816/fullambulatory blood pressure variabilityischemic strokelarge-artery atherosclerosisbranch atheromatous diseasesmall-vessel diseasecardioembolic stroke |
| spellingShingle | Lijuan Wang Lijuan Wang Xiaoshuang Xia Xin Liu Guilin Wu Yanna Wang Dongliang Yang Peilin Liu Zhuangzhuang Chen Lin Wang Xin Li Twenty-four-hour ambulatory blood pressure variability and association with ischemic stroke subtypes in the subacute stage Frontiers in Neurology ambulatory blood pressure variability ischemic stroke large-artery atherosclerosis branch atheromatous disease small-vessel disease cardioembolic stroke |
| title | Twenty-four-hour ambulatory blood pressure variability and association with ischemic stroke subtypes in the subacute stage |
| title_full | Twenty-four-hour ambulatory blood pressure variability and association with ischemic stroke subtypes in the subacute stage |
| title_fullStr | Twenty-four-hour ambulatory blood pressure variability and association with ischemic stroke subtypes in the subacute stage |
| title_full_unstemmed | Twenty-four-hour ambulatory blood pressure variability and association with ischemic stroke subtypes in the subacute stage |
| title_short | Twenty-four-hour ambulatory blood pressure variability and association with ischemic stroke subtypes in the subacute stage |
| title_sort | twenty four hour ambulatory blood pressure variability and association with ischemic stroke subtypes in the subacute stage |
| topic | ambulatory blood pressure variability ischemic stroke large-artery atherosclerosis branch atheromatous disease small-vessel disease cardioembolic stroke |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2023.1139816/full |
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