Correlation between systolic blood pressure at admission and etiological subtype of cerebral infarction_West China Medical Journal

Authors：

JIANG Xiaoqun ¹ , WANG Yan ¹ , JIANG Yanhong ¹ ,  LIU Junfeng ²

1. Geriatric Diseases Institute of Chengdu, Department of Neurology, Chengdu Fifth People’s Hospital (the Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, Sichuan 611137, P. R. China;
2. Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LIU Junfeng, Email: junfengliu225@outlook.com

Keywords：

Cerebral infarction; blood pressure; etiology subtype

DOI：

10.7507/1002-0179.202205058

Video：

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Objective To investigate the relationship between systolic blood pressure (SBP) and etiological subtype in patients with cerebral infarction. Methods Retrospective analysis was made on the data of patients with cerebral infarction admitted to West China Hospital of Sichuan University between January 2015 and March 2018. Patients within 24 h of symptom were included. Etiological subtypes were classified according to Trial of Org 10172 in Acute Stroke Treatment criteria. Multinomial logistic regression was used to analyze the correlation between SBP at admission and etiological subtype. Results A total of 944 eligible cases were included, accounting for 37.3% (944/2528) of the total number of registered cases. The mean age was (65.35±14.17) years, and 57.5% (543/944) were male. The median time from onset to admission was 15 h, with 54.7% (516/944) of patients having elevated blood pressure. Among the patients, large artery atherosclerosis, small artery occlusion, cardiogenic embolism, other definite causes and undetermined causes accounted for 24.9% (235 cases), 21.2% (200 cases), 20.0% (189 cases), 1.8% (17 cases), and 32.1% (303 cases), respectively. Multinomial analysis showed that there was a significant negative correlation between SBP at admission and cardioembolic etiology [odds ratio (OR)=0.987, 95% confidence interval (CI) (0.977, 0.998)]; normal SBP at admission [<140 mm Hg (1 mm Hg=0.133 kPa)] was significantly positively correlated with cardioembolic etiology [OR=2.016, 95%CI (1.211, 3.357)]. Conclusion Normal SBP at admission with acute cerebral infarction predicts cardioembolic etiology, which will be helpful for clinicians to make individual decision based on the pathogenesis in the early stage.

Citation： JIANG Xiaoqun, WANG Yan, JIANG Yanhong, LIU Junfeng. Correlation between systolic blood pressure at admission and etiological subtype of cerebral infarction. West China Medical Journal, 2022, 37(12): 1793-1797. doi: 10.7507/1002-0179.202205058 Copy

1.	Weiss A, Beloosesky Y, Kenett RS, et al. Systolic blood pressure during acute stroke is associated with functional status and long-term mortality in the elderly. Stroke, 2013, 44(9): 2434-2440.
2.	谭燕, 刘鸣, 王清芳, 等. 脑卒中急性期血压与预后的关系. 中华神经科杂志, 2006, 39(1): 10-15.
3.	尚文锦, 周晓明, 洪华. 脑梗死 TOAST 各型急性期血压进程与预后差异. 中山大学学报(医学科学版), 2016, 37(2): 260-265.
4.	于丽, 袁建新, 李壬子. 不同 TOAST 分型的缺血性卒中急性期高血压的特点及其对预后的影响. 中国卒中杂志, 2012, 7(3): 163-171.
5.	Marcheselli S, Cavallini A, Tosi P, et al. Impaired blood pressure increase in acute cardioembolic stroke. J Hypertens, 2006, 24(9): 1849-1856.
6.	Altmann M, Thommessen B, Rønning OM, et al. Blood pressure differences between patients with lacunar and nonlacunar infarcts. Brain Behav, 2015, 5(8): e00353.
7.	WHO Task Force on Stroke and other Cerebrovascular Disorders Stroke-1989. Recommendations on stroke prevention, diagnosis, and therapy. Report of the WHO Task Force on Stroke and other Cerebrovascular Disorders. Stroke, 1989, 20(10): 1407-1431.
8.	Wu B, Lin S, Hao Z, et al. Proportion, risk factors and outcome of lacunar infarction: a hospital-based study in a Chinese population. Cerebrovasc Dis, 2010, 29(2): 181-187.
9.	Adams HP Jr, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke, 1993, 24(1): 35-41.
10.	Meurer WJ, Sánchez BN, Smith MA, et al. Predicting ischaemic stroke subtype from presenting systolic blood pressure: the BASIC Project. J Intern Med, 2009, 265(3): 388-396.
11.	谭燕, 刘鸣, 王清芳, 等. 脑卒中急性期血压变化及其影响因素. 高血压杂志, 2005(11): 701-705.
12.	Wallace JD, Levy LL. Blood pressure after stroke. JAMA, 1981, 246(19): 2177-2180.
13.	Harper G, Castleden CM, Potter JF. Factors affecting changes in blood pressure after acute stroke. Stroke, 1994, 25(9): 1726-1729.
14.	Vemmos KN, Spengos K, Tsivgoulis G, et al. Factors influencing acute blood pressure values in stroke subtypes. J Hum Hypertens, 2004, 18(4): 253-259.
15.	Myers MG, Norris JW, Hachniski VC, et al. Plasma norepinephrine in stroke. Stroke, 1981, 12(2): 200-204.
16.	Carlberg B, Asplund K, Hägg E. High blood pressure in acute stroke-is it white coat hypertension?. J Intern Med, 1990, 228(3): 291-292.
17.	Ito A, Omae T, Katsuki S. Acute changes in blood pressure following vascular diseases in the brain stem. Stroke, 1973, 4(1): 80-84.
18.	Vemmos KN, Tsivgoulis G, Spengos K, et al. Blood pressure course in acute ischaemic stroke in relation to stroke subtype. Blood Press Monit, 2004, 9(3): 107-114.
19.	Toyoda K, Okada Y, Fujimoto S, et al. Blood pressure changes during the initial week after different subtypes of ischemic stroke. Stroke, 2006, 37(10): 2637-2639.
20.	Moores M, Yogendrakumar V, Bereznyakova O, et al. Normal systolic blood pressure at presentation with acute ischemic stroke predicts cardioembolic etiology. J Am Heart Assoc, 2020, 9(1): e014399.
21.	吴丽娥, 刘鸣, 张月辉, 等. 缺血性脑卒中 TOAST 病因分型和预后. 中华神经科杂志, 2004, 37(4): 292-295.

1. Weiss A, Beloosesky Y, Kenett RS, et al. Systolic blood pressure during acute stroke is associated with functional status and long-term mortality in the elderly. Stroke, 2013, 44(9): 2434-2440.
2. 谭燕, 刘鸣, 王清芳, 等. 脑卒中急性期血压与预后的关系. 中华神经科杂志, 2006, 39(1): 10-15.
3. 尚文锦, 周晓明, 洪华. 脑梗死 TOAST 各型急性期血压进程与预后差异. 中山大学学报(医学科学版), 2016, 37(2): 260-265.
4. 于丽, 袁建新, 李壬子. 不同 TOAST 分型的缺血性卒中急性期高血压的特点及其对预后的影响. 中国卒中杂志, 2012, 7(3): 163-171.
5. Marcheselli S, Cavallini A, Tosi P, et al. Impaired blood pressure increase in acute cardioembolic stroke. J Hypertens, 2006, 24(9): 1849-1856.
6. Altmann M, Thommessen B, Rønning OM, et al. Blood pressure differences between patients with lacunar and nonlacunar infarcts. Brain Behav, 2015, 5(8): e00353.
7. WHO Task Force on Stroke and other Cerebrovascular Disorders Stroke-1989. Recommendations on stroke prevention, diagnosis, and therapy. Report of the WHO Task Force on Stroke and other Cerebrovascular Disorders. Stroke, 1989, 20(10): 1407-1431.
8. Wu B, Lin S, Hao Z, et al. Proportion, risk factors and outcome of lacunar infarction: a hospital-based study in a Chinese population. Cerebrovasc Dis, 2010, 29(2): 181-187.
9. Adams HP Jr, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke, 1993, 24(1): 35-41.
10. Meurer WJ, Sánchez BN, Smith MA, et al. Predicting ischaemic stroke subtype from presenting systolic blood pressure: the BASIC Project. J Intern Med, 2009, 265(3): 388-396.
11. 谭燕, 刘鸣, 王清芳, 等. 脑卒中急性期血压变化及其影响因素. 高血压杂志, 2005(11): 701-705.
12. Wallace JD, Levy LL. Blood pressure after stroke. JAMA, 1981, 246(19): 2177-2180.
13. Harper G, Castleden CM, Potter JF. Factors affecting changes in blood pressure after acute stroke. Stroke, 1994, 25(9): 1726-1729.
14. Vemmos KN, Spengos K, Tsivgoulis G, et al. Factors influencing acute blood pressure values in stroke subtypes. J Hum Hypertens, 2004, 18(4): 253-259.
15. Myers MG, Norris JW, Hachniski VC, et al. Plasma norepinephrine in stroke. Stroke, 1981, 12(2): 200-204.
16. Carlberg B, Asplund K, Hägg E. High blood pressure in acute stroke-is it white coat hypertension?. J Intern Med, 1990, 228(3): 291-292.
17. Ito A, Omae T, Katsuki S. Acute changes in blood pressure following vascular diseases in the brain stem. Stroke, 1973, 4(1): 80-84.
18. Vemmos KN, Tsivgoulis G, Spengos K, et al. Blood pressure course in acute ischaemic stroke in relation to stroke subtype. Blood Press Monit, 2004, 9(3): 107-114.
19. Toyoda K, Okada Y, Fujimoto S, et al. Blood pressure changes during the initial week after different subtypes of ischemic stroke. Stroke, 2006, 37(10): 2637-2639.
20. Moores M, Yogendrakumar V, Bereznyakova O, et al. Normal systolic blood pressure at presentation with acute ischemic stroke predicts cardioembolic etiology. J Am Heart Assoc, 2020, 9(1): e014399.
21. 吴丽娥, 刘鸣, 张月辉, 等. 缺血性脑卒中 TOAST 病因分型和预后. 中华神经科杂志, 2004, 37(4): 292-295.

West China Medical Journal

Correlation between systolic blood pressure at admission and etiological subtype of cerebral infarction

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