Ryan Daniel J, Kenny Rose Anne, Finucane Ciaran, Meaney James F, Collins Daniel R, Walsh Suzanne, Harbison Joseph A
Department of Medical Gerontology, Trinity College, Dublin, Ireland.
Acute Stroke Service, St James's Hospital, Dublin, Ireland.
Eur Stroke J. 2016 Sep;1(3):222-230. doi: 10.1177/2396987316663287. Epub 2016 Aug 4.
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.
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.
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%, = 0.003, group 2: 12.5%, = 0.0004, Fisher's exact). Mean baseline systolic BP (SBP) was significantly higher in cases (cases: 150 mm Hg, group 1: 140 mm Hg, = 0.03, group 2: 143 mm Hg, = 0.1). Ten seconds after standing, SBP dropped significantly less in cases (cases: -14.1 mm Hg, group 1: -31.4 mm Hg, < 0.0005, group 2: -27.3 mm Hg, = 0.001, test). Diastolic BP also fell significantly less in cases. Cases' SBP and DBP recovered to, then persistently overshot baseline levels.
Subjects with MR-defined lacunar stroke, of likely small vessel aetiology, exhibit orthostatic hypertension compared with population norms.
高血压是腔隙性卒中公认的危险因素。然而，二者的关联仅通过仰卧位或坐位时的静态血压（BP）评估来进行评价。我们推测动态（直立位）血压控制受损可能与腔隙性卒中有关。
将连续入选的经证实患有二尖瓣反流（MR）的腔隙性卒中患者与两个对照组进行比较。首先是年龄和性别匹配的“正常”人群对照组（比例为1:3），然后是年龄、性别、高血压病史和抗高血压药物治疗情况相匹配的“风险”对照组（比例为1:2）。通过主动站立试验并连续、逐相、逐搏测量血压来评估直立位血压控制情况。
36例患者（平均年龄69.9岁）与第1组的108名对照组和第2组的72名对照组进行比较。腔隙性卒中患者中晕厥的发生率更高（病例组：44.4%，第1组：17.6%，P = 0.003，第2组：12.5%，P = 0.0004，Fisher精确检验）。病例组的平均基线收缩压（SBP）显著更高（病例组：150 mmHg，第1组：140 mmHg，P = 0.03，第2组：143 mmHg，P = 0.1）。站立10秒后，病例组的SBP下降明显更少（病例组：-14.1 mmHg，第1组：-31.4 mmHg，P < 0.0005，第2组：-27.3 mmHg，P = 0.001，t检验）。病例组的舒张压下降也明显更少。病例组的SBP和DBP恢复到然后持续超过基线水平。
与人群标准相比，由MR定义的、可能由小血管病因导致的腔隙性卒中患者表现出直立性高血压。
