title: A stress-related explanation to the increased blood pressure and its course following ischemic stroke.
abstract: BACKGROUND
  A hypertensive response after ischemic stroke is frequent, yet its pathophysiology is unknown. Mechanisms related to local ischemic damage, major vascular occlusion, and psychological stress due to acute illness have been proposed. We assessed the natural course of blood pressure (BP) within the first 24 h in groups of ischemic stroke patients with different characteristics. We hypothesized that a consistent BP reduction, regardless of stroke location, time window from debut to admission and presence of persistent vascular occlusion, would favor a stress-related mechanism as an important cause of the hypertensive response after ischemic stroke.
  
  
  METHODS
  Ischemic stroke patients (n=1067) were prospectively registered, and BP was measured on admission and <3 h, 3-6 h, 6-12 h and 12-24 h after admission. Patients were categorized according to the location of diffusion-weighted imaging (DWI) lesions (cortical, large subcortical, mixed cortico-subcortical, lacunar, cerebellar, brain stem or multiple), time window (admitted within or after 6 h of symptom onset) and presence of persistent proximal middle cerebral artery (MCA) occlusion versus normal findings on magnetic resonance angiography (MRA) at 24 h.
  
  
  RESULTS
  A reduction in systolic BP and diastolic BP from baseline to 12-24 h was found across all DWI locations except for diastolic BP in cerebellar (P=0.072) lesions. Apart from diastolic BP in patients with normal MRA findings at 24 h (P=0.060), a significant fall in systolic BP and diastolic BP at 12-24 h was registered, irrespective of whether patients were admitted within 6 h or after 6 h of stroke onset or had persistent MCA occlusion versus normal MRA findings.
  
  
  CONCLUSIONS
  We found a relatively consistent decline in BP within 24 h after admission across different stroke locations in patients admitted within or after 6 h of stroke onset and in patients with persistent MCA occlusion. Our findings suggest that a systemic factor such as psychological stress may be an important contributor to the frequently elevated BP on admission in patients with ischemic stroke.
authors.affiliation: Department of Neurology, Haukeland University Hospital, Bergen, Norway.
authors.forename: Christopher Elnan
authors.initials: CE
authors.lastname: Kvistad
authors.affiliation: Department of Neurology, Haukeland University Hospital, Bergen, Norway.
authors.forename: Halvor
authors.initials: H
authors.lastname: Oygarden
authors.affiliation: Department of Neurology, Haukeland University Hospital, Bergen, Norway.
authors.forename: Nicola
authors.initials: N
authors.lastname: Logallo
authors.affiliation: Department of Neurology, Haukeland University Hospital, Bergen, Norway.
authors.forename: Lars
authors.initials: L
authors.lastname: Thomassen
authors.affiliation: Department of Neurology, Haukeland University Hospital, Bergen, Norway.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Waje-Andreassen
authors.affiliation: Department of Neurology, Haukeland University Hospital, Bergen, Norway.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Moen
authors.affiliation: Department of Neurology, Haukeland University Hospital, Bergen, Norway.
authors.forename: Halvor
authors.initials: H
authors.lastname: Naess
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D002545:Brain Ischemia / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D013315:Stress, Psychological / Q000150:complications* / Q000175:diagnosis; D020521:Stroke / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D013997:Time Factors
keywords: DWI; blood pressure; hypertensive response; ischemic stroke