title: Acute hypertensive response in ischemic stroke is associated with increased aortic stiffness.
abstract: Acute hypertensive response (AHR) affects more than 60% of patients with ischemic stroke and is associated with poor outcomes. We hypothesized that its development is related to arterial stiffening. "The gold standard" estimate of arterial stiffness is carotid-femoral pulse wave velocity (CF-PWV). We compared CF-PWV and indirect indices of arterial stiffness (central augmentation index (cAIxHR), central systolic (cSBP) and pulse (cPP) pressures) between acute ischemic stroke patients who developed AHR and those who were normotensive in the early phase of stroke.
  
  
  
  AHR was assessed through hourly BP measurements within 24 h from admission using an oscillometric device. The stiffness was assessed using applanation tonometry with a SphygmoCor(®) device (Atcor, Sydney, Australia) 7 ± 2 days after stroke.
  
  
  
  Among 102 patients with acute ischemic stroke, 73(71.5%) met AHR criteria. In an univariate analysis, CF-PWV, cAIxHR, cSBP and cPP were higher in those who developed AHR (10.9 vs. 8.3 m/s, p < 0.001; 30.8 vs. 23.9%, p = 0.004; 138.2 vs. 117.2 mmHg, p < 0.001; 54.6 vs. 44 mmHg, p = 0.005, respectively). In a multivariate logistic regression analysis, CF-PWV was independently associated with AHR after adjustment for age and peripheral mean blood pressure (pMBP) (p = 0.04), for age, pMBP and diabetes mellitus (DM) (p = 0.045), and age, pMBP, DM and hypertension (p = 0.047).
  
  
  
  This study revealed for the first time that AHR in ischemic stroke is associated with elevated aortic stiffness independently of other clinical factors including age and hypertension preceding stroke. A potential pathophysiological mechanism responsible for this relationship includes impaired baroreceptor function in stiff arteries resulting in impaired BP autoregulation.
authors.affiliation: Department of Adult Neurology, Medical University of Gdansk & University Clinical Centre in Gdansk, ul. Dębinki 7, 80-211 Gdańsk, Poland.
authors.forename: Mariusz
authors.initials: M
authors.lastname: Kwarciany
authors.affiliation: Department of Adult Neurology, Medical University of Gdansk & University Clinical Centre in Gdansk, ul. Dębinki 7, 80-211 Gdańsk, Poland.
authors.forename: Dariusz
authors.initials: D
authors.lastname: Gąsecki
authors.affiliation: Department of Adult Neurology, Medical University of Gdansk & University Clinical Centre in Gdansk, ul. Dębinki 7, 80-211 Gdańsk, Poland.
authors.forename: Kamil
authors.initials: K
authors.lastname: Kowalczyk
authors.affiliation: Department of Hypertension and Diabetology, Medical University of Gdansk & University Clinical Centre in Gdansk, ul. Dębinki 7, 80-211 Gdańsk, Poland.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Rojek
authors.affiliation: Department of Pharmacology, Université Paris Descartes 7, INSERM U970, HEGP Assistance Publique-Hôpitaux de Paris, 20 rue Leblanc, 75015 Paris, France.
authors.forename: Stephane
authors.initials: S
authors.lastname: Laurent
authors.affiliation: Department of Pharmacology, Université Paris Descartes 7, INSERM U970, HEGP Assistance Publique-Hôpitaux de Paris, 20 rue Leblanc, 75015 Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Boutouyrie
authors.affiliation: Department of Adult Neurology, Medical University of Gdansk & University Clinical Centre in Gdansk, ul. Dębinki 7, 80-211 Gdańsk, Poland; Department of Nursing, Medical University of Gdansk, ul. Dębinki 7, 80-211 Gdańsk, Poland.
authors.forename: Marcelina
authors.initials: M
authors.lastname: Skrzypek-Czerko
authors.affiliation: Department of Adult Neurology, Medical University of Gdansk & University Clinical Centre in Gdansk, ul. Dębinki 7, 80-211 Gdańsk, Poland.
authors.forename: Walenty M
authors.initials: WM
authors.lastname: Nyka
authors.affiliation: Department of Hypertension and Diabetology, Medical University of Gdansk & University Clinical Centre in Gdansk, ul. Dębinki 7, 80-211 Gdańsk, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Narkiewicz
authors.affiliation: Department of Adult Neurology, Medical University of Gdansk & University Clinical Centre in Gdansk, ul. Dębinki 7, 80-211 Gdańsk, Poland. Electronic address: bartosz@karaszewski.org.
authors.forename: Bartosz
authors.initials: B
authors.lastname: Karaszewski
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001011:Aorta / Q000503:physiopathology*; D001783:Blood Flow Velocity; D001794:Blood Pressure; D001921:Brain / Q000473:pathology; D002545:Brain Ischemia / Q000473:pathology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006973:Hypertension; D007511:Ischemia; D008297:Male; D008875:Middle Aged; D009991:Oscillometry; D063177:Pulse Wave Analysis; D020521:Stroke / Q000473:pathology*; D013599:Systole; D059289:Vascular Stiffness
keywords: Acute hypertensive response; Aortic stiffness; Hypertension; Pulse wave velocity; Stroke