Analysis of arterial pressure variability in patients with acute cerebral stroke depending on the time of occurrence.

Abstract

Arterial hypertension can cause a pronounced negative influence on the state of the cerebral vascular system and lead to significant microtraumatization of the walls of the vessels and disruption of vascular autoregulation. This predictor has the greatest influence on the onset of ischemic stroke of atherothrombotic and lacunar subtypes, however, hypertension occurs almost in all patients with acute cerebral ischemia. Interesting and not at all presented in modern scientific literature is the question of the relationship of oscillation of blood pressure with the period of the onset of the focus of ischemia, which predetermined the purpose of our work. The purpose of our study was to determine the relationship between deformation of the profile of fluctuations in blood pressure of patients in the acute period of ischemic stroke, depending on the time of the occurrence of cerebrovascular accident. We examined 300 patients who suffered acute ischemic stroke (men - 196, women - 104) aged 42 to 84 years (average age - 65.2 ± 8.7 years). All patients were divided into 3 groups according to the period of the day when an ischemic stroke occurred: 1 group (n=146), patients suffering from cerebral ischemia during the day (8.00-14.59); In group 2 (n=107), patients stroke was observed in the evening (15.00-21.59); Group 3 (n=47), patients had an ischemic stroke at night (22.00-7.59). For the 1st group of patients who have had ischemic stroke during the day and as a rule with an increase in blood pressure, a marked increase in blood pressure was at 12.00 and 15.00 and a tendency towards compensatory parasympathetic effect in the form of blood pressure decrease at night (over-dipper) was typical. At the same time, in the 2nd group of patients with stroke in the evening, elevated blood pressure at 18.00 and 21.00 and parasympathetic activity disorders with prevalence of insufficient reduction of blood pressure in the evening and during sleep (non-dipper) was observed. For patients with a nocturnal stroke (3rd group), there were two peaks of elevated blood pressure at 9.00 and 21.00 and a significant increase in night-peaking at night, which usually resulted in a cerebrovascular catastrophe. Sharp changes in human biorhythm significantly affect the violation of the regulation of the vegetative-vascular system and lead to a breakdown in the regulation of vascular tone with the emergence of phenomena of "vegetative storm" and sharp increase in blood pressure by the type of "night peacker". This effect is also caused by chronic alcohol intoxication, presumably due to the toxic damage of the hypothalamic-pituitary complex due to the high permeability of the blood-brain barrier in this area of the brain due to over-active hormonal-regulatory diffusion.