Association of Morning Blood Pressure Surge with Carotid Artery Plaque Ulceration in Ischemic Stroke Patients with Pathogenesis of Artery to Artery Embolism

Abstract

Abstract:

【Abstract】 Objective To investigate the association of morning blood pressure surge (MBPS) with carotid artery plaque ulceration (CAPU) in ischemic stroke (IS) patients. Methods One hundred and twenty IS patients diagnosed with artery to artery embolism based on Chinese Ischemic Stroke Subclassification (CISS) were enrolled in this study. MBPS was monitored by ambulatory blood pressure monitoring within 24 hours, and CAPU was examined by carotid ultrasonography. The association of MBPS with CAPU was evaluated by the Logistic regression model. Results The mean age of the total 120 IS patients was (62.6±12.8) years old, and 36.8% was female. Compared with the MBPS- group (n=72), the MBPS+ group (n=48) did not have higher detection rate of CAPU (31.3% vs 30.6%, P=0.84). After separation of ipsilateral CAPU and contralateral CAPU, we found the detection rate was higher in MBPS+ group than MBPS- group (27.1% vs 19.4%, P=0.008). The multivariate analysis showed that MBPS was associated with ipsilateral CAPU (odds ratio[OR], 1.42; 95%confidence interval[CI], 1.09~4.22) after adjusting for age and sex. The association still existed after further adjusting for other risk factors (OR 1.23; 95%CI 1.02~3.46). Conclusion MBPS is associated with ipsilateral CAPU in the IS patients with pathogenesis of artery to artery embolism, which implies that higher MBPS may contribute to the fall of plaque that led to the occurrence of artery to artery embolism.

Key words: Morning blood pressure surge; Carotid artery plaque ulceration; Ischemic stroke

摘要：

【摘要】目的在动脉-动脉栓塞性缺血性卒中患者中，探讨晨峰高血压与颈动脉溃疡斑块的相关性。方法连续入组120例经中国缺血性卒中亚型（Chinese Ischemic Stroke Subclassification，CISS）分型诊断为动脉-动脉栓塞性缺血性卒中患者，利用24 h动态血压监测以及颈动脉彩超分别监测晨峰血压及颈动脉溃疡斑块。利用Logistic回归模型，研究晨峰血压与颈动脉溃疡斑块的相关性。结果 120例缺血性卒中患者的平均年龄为（62.6±12.8）岁，女性占36.8%。晨峰高血压组（n=48）溃疡斑块的检出率与无晨峰高血压组（n=72）相比，差异无显著性（31.3％ vs 30.6％，P=0.84）。进一步将溃疡斑块按照检出部位（出现在卒中病灶同侧颈动脉或对侧颈动脉）进行分类发现，晨峰高血压组病灶同侧溃疡斑块的检出率明显高于无晨峰高血压组（27.1% vs 19.4%，P=0.008）。多因素分析的结果显示，在调整了年龄、性别之后，晨峰高血压与病灶同侧溃疡斑块的相关性具有统计学意义[优势比（odds ratio，OR）：1.42；95%可信区间（confidence interval，CI）：1.09～4.22）］；进一步校正其他危险因素之后，两者相关性仍存在（OR 1.23；95%CI 1.02～3.46）。结论在动脉-动脉栓塞性缺血性卒中患者中，晨峰高血压与卒中病灶同侧颈动脉溃疡斑块的检出率具有相关性，提示过高的晨峰血压可能是颈动脉溃疡斑块脱落导致动脉-动脉栓塞型缺血性卒中发病的危险因素。

关键词: 晨峰血压; 颈动脉溃疡斑块; 缺血性卒中

CHENG Wei*, BAO Yan-Er, NIE Li, LI Wan-Qiu, QIAO Xiang-Liang, CHENG Xiao-Ling.. Association of Morning Blood Pressure Surge with Carotid Artery Plaque Ulceration in Ischemic Stroke Patients with Pathogenesis of Artery to Artery Embolism[J]. Chinese Journal of Stroke, 2013, 8(08): 603-607.

程伟1，包艳娥2，聂莉1，李婉秋1，乔向亮1，程晓玲1. 动脉-动脉栓塞性缺血性卒中患者晨峰血压与颈动脉溃疡斑块的相关性研究[J]. 中国卒中杂志, 2013, 8(08): 603-607.

References

1 Nichols WW, Pepine CJ, O'Rourke MF. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke[J]. N Engl J Med, 1999, 340:1762-1763.

2 Rothwell PM, Gibson R, Warlow C. Interrelation between plaque surface morphology and degree of stenosis on carotid angiograms and the risk of ischemic stroke in patients with symptomatic carotid stenosis[J]. Stroke, 2000, 31:615-621.

3 Eliasziw M, Streifler JY, Fox AJ, et al. Significance of plaque ulceration in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial[J]. Stroke, 1994, 25:304-308.

4 Schulz UG, Rothwell PM. Major variation in carotid bifurcation anatomy a possible risk factor for plaque development?[J]. Stroke, 2001, 32:2522-2529.

5 Kario K, Yano Y, Matsuo T, et al. Additional impact of morning haemostatic risk factors and morning blood pressure surge on stroke risk in older Japanese hypertensive patients[J]. Eur Heart J, 2011, 32:574-580.

6 中华人民共和国卫生部疾病预防控制局. 中国脑血管病防治指南[M]. 北京:人民卫生出版社, 2007:47-48.

7 Gao S, Wang Y, Xu A, et al. Chinese ischemic stroke subclassification[J]. Front Neurol, 2011, 2:1-5.

8 中国成人血脂异常防治指南制订联合委员会. 中国成人血脂异常防治指南[J]. 中华心血管病杂志, 2007, 35:390-419.

9 中国高血压防治指南修订委员会. 中国高血压防治指南2010[J]. 中华高血压杂志, 2011, 19:701-743.

10 中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2010年版)[J]. 中国糖尿病杂志, 2012, 20:81-117.

11 Marfella R, Siniscalchi M, Portoghese M, et al.Morning blood pressure surge as a destabilizing factor of atherosclerotic plaque role of ubiquitin-proteasome activity[J]. Hypertension, 2007, 49:784-791.

12 Kern R, Szabo K, Hennerici M, et al. Characterization of carotid artery plaques using real-time compound B-mode ultrasound[J]. Stroke, 2004, 35:870-875.

13 Giannoni MF, Vicenzini E. Focus on the unstable carotid plaque:Detection of intraplaque angiogenesis with contrast ultrasound. Present state and future perspectives[J]. Curr Vasc Pharmacol, 2009, 7:180-184.

14 Fisher M, Paganini-Hill A, Martin A, et al. Carotid plaque pathology thrombosis, ulceration, and stroke pathogenesis[J]. Stroke, 2005, 36:253-257.

15 Homburg PJ, Rozie S, van Gils MJ, et al. Association between carotid artery plaque ulceration and plaque composition evaluated with multidetector CT angiography[J]. Stroke, 2011, 42:367-372.

16 Wechsler LR. Ulceration and carotid artery disease[J]. Stroke, 1988, 19:650-653.

17 Liu Z, Lu F, Pan H, et al. Correlation of peripheral Th17 cells and Th17-associated cytokines to the severity of carotid artery plaque and its clinical implication[J]. Atherosclerosis, 2012, 221:232-241.

18 Lee KB, Budoff MJ, Zavodni A, et al. Coronary artery calcium is associated with degree of stenosis and surface irregularity of carotid artery[J]. Atherosclerosis, 2012, 223:160-165.

19 Epstein FH, Fuster V, Badimon L, et al. The pathogenesis of coronary artery disease and the acute coronary syndromes[J]. N Engl J Med, 1992, 326:242-250.

20 Iwata S, Jin Z, Schwartz JE, et al. Relationship between ambulatory blood pressure and aortic arch atherosclerosis[J]. Atherosclerosis, 2012, 221:427-431.

21 Kario K. Morning surge in blood pressure and cardiovascular risk evidence and perspectives[J]. Hypertension, 2010, 56:765-773.

22 王琳, 赵性泉. 颈动脉粥样硬化斑块高分辨磁共振成像与脑梗死[J]. 中国卒中杂志, 2013, 8:221-225.

23 娄昕. 磁共振成像:评估动脉粥样硬化斑块的重要影像检查方法[J]. 中国卒中杂志, 2012, 7:835-838.

[1]	WU Yuqian, ZHANG Yumei, FAN Xiaowei, WANG Anxin, PANG Wenbin. The Efficacy of Kinesthetic Motor Imagery Therapy for Hand Function Rehabilitation of Stroke Patients [J]. Chinese Journal of Stroke, 2022, 17(12): 1366-1371.
[2]	YI Luo, ZHOU Hongyu, QIU Xin, LI Zixiao, WANG Yongjun. DNA Methylation Changes in Atherosclerotic Diseases [J]. Chinese Journal of Stroke, 2022, 17(11): 1163-1170.
[3]	WANG Yubo, LI Zixiao, WANG Yongjun. Progress of the Relationship between Epigenetics and Oxidative Stress after Ischemic Stroke [J]. Chinese Journal of Stroke, 2022, 17(11): 1171-1177.
[4]	CUI Lingyun, QIU Xin, ZHOU Hongyu, LI Zixiao, WANG Yongjun. Progress of the Relationship between DNA Methylation and Type 2 Diabetes [J]. Chinese Journal of Stroke, 2022, 17(11): 1183-1188.
[5]	LIU Guangliang, HAN Kaiyue, SU Wenlong, ZHANG Hao. Effects of Aerobic Cycling Training Intensity on Motor and Cardiopulmonary Fitness in Patients with Ischemic Stroke [J]. Chinese Journal of Stroke, 2022, 17(11): 1203-1208.
[6]	XU Yingxin, ZHANG Shuang, ZHOU Xiaomei, YUAN Jinglin, ZHAO Liuzhuang, YANG Haihua. Correlation of Non-Stenotic Carotid Plaque with Anterior Circulation Embolic Stroke of Undetermined Source [J]. Chinese Journal of Stroke, 2022, 17(11): 1233-1237.
[7]	CHENG Shi, LI Jing, GUO Junping, HU Aixiang, YU Xinwei, HAN Wei, LIANG Ying, ZHANG Yuewei, JI Ruijun. Clinical Characteristics and Risk Factors of Infection in Patients with Acute Stroke during Hospitalization [J]. Chinese Journal of Stroke, 2022, 17(10): 1065-1070.
[8]	XIANG Wei, XU Luyao, ZHANG Manman, WEI Hongchun, LIANG Zhigang. The Frequency and Influencing Factors of Asymmetrical Prominent Veins Sign on Susceptibility-Weighted Imaging in Acute Ischemic Stroke [J]. Chinese Journal of Stroke, 2022, 17(10): 1097-1102.
[9]	ZHAO Yongrui, LIU Zhanhui. Progress of Diffusion Tensor Imaging in Evaluating Motor Function Prognosis of Patients with Ischemic Stroke [J]. Chinese Journal of Stroke, 2022, 17(10): 1114-1119.
[10]	ZHANG Boyu, GUO Yucheng, CUI Yuxia, LI Yingli, LYU Yumei. Seeking Medical Services Decision-Making Status and Relevant Influencing Factors in Patients with Acute Ischemic Stroke: A Review [J]. Chinese Journal of Stroke, 2022, 17(10): 1127-1132.
[11]	WU Tingting, LIU Yafei, YAN Shixi, WU Yiping, ZHANG Zhongbo, ZAHNG Hanfei, FANG Pinping. Application of “Internet Plus” in Emergency Care of Acute Ischemic Stroke [J]. Chinese Journal of Stroke, 2022, 17(10): 1133-1138.
[12]	ZHANG Yige, ZHANG Wan, ZHANG Luyang, WANG Xin, DING Lan, WANG Yuying, PEI Lulu, FANG Hui, XU Yuming, SONG Bo. Association of Artery Occlusion and Recurrent Ischemic Stroke Related with Cerebral Artery Dissection [J]. Chinese Journal of Stroke, 2022, 17(09): 932-936.
[13]	LYU Wei, WANG Anxin, TIAN Xue, ZHANG Xiaoli, XU Yuyuan, MENG Xia. Effect of Xinxuening Capsule on Short-term Functional Outcome in Patients with Ischemic Stroke and High Homocysteine Level [J]. Chinese Journal of Stroke, 2022, 17(09): 972-976.
[14]	ZHANG Xinmiao, PAN Yuesong, XIANG Xianglong, WANG Yongjun, MENG Xia. Early Clinical Pathway Intervention to Improve the Key Performance Indicators of Medical Care for Ischemic Stroke [J]. Chinese Journal of Stroke, 2022, 17(09): 977-984.
[15]	GONG Yutian, LI Jiejie. Advances in the Relationship between IL-6 and Atherosclerotic Ischemic Stroke [J]. Chinese Journal of Stroke, 2022, 17(09): 1022-1026.