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Gunkel S, Schötzau A, Fluri F. Burden of cerebral small vessel disease and changes of diastolic blood pressure affect clinical outcome after acute ischemic stroke. Sci Rep 2023; 13:22070. [PMID: 38086878 PMCID: PMC10716411 DOI: 10.1038/s41598-023-49502-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 12/08/2023] [Indexed: 12/18/2023] Open
Abstract
Elevated and low blood pressure (BP) may lead to poor functional outcome after ischemic stroke, which is conflicting. Hence, there must be another factor-such as cerebral small vessel disease (cSVD) -interacting with BP and thus, affecting outcome. Here, we investigate the relationship between BP and cSVD regarding outcome after stroke. Data of 423/503 stroke patients were prospectively analyzed. Diastolic (DBP) and systolic BP (SBP) were collected on hospital admission (BPad) and over the first 72 h (BP72h). cSVD-burden was determined on MR-scans. Good functional outcome was defined as a modified Rankin Scale score ≤ 2 at hospital discharge and 12 months thereafter. cSVD was a predictor of poor outcome (OR 2.8; p < 0.001). SBPad, DBPad and SBP72h were not significantly associated with outcome at any time. A significant relationship was found between DBP72h, (p < 0.01), cSVD (p = 0.013) and outcome at discharge. At 12 months, we found a relationship between outcome and DBP72h (p = 0.018) and a statistical tendency regarding cSVD (p = 0.08). Changes in DBP72h were significantly related with outcome. There was a U-shaped relationship between DBP72h and outcome at discharge. Our results suggest an individualized stroke care by either lowering or elevating DBP depending on cSVD-burden in order to influence functional outcome.
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Affiliation(s)
- Sarah Gunkel
- Department of Neurology, University Hospital Würzburg, Josef-Schneider Strasse 11, 97080, Würzburg, Germany
| | - Andreas Schötzau
- Eudox Statistics, Basel, Switzerland
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Felix Fluri
- Department of Neurology, University Hospital Würzburg, Josef-Schneider Strasse 11, 97080, Würzburg, Germany.
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Osman H, Lane D, Bernieh D, Seidu S, Patel P, Khunti K, Brunskill NJ, Xu G, Gupta P. An Innovative Chemical Adherence Test Demonstrates Very High Rates of Nonadherence to Oral Cardio-Metabolic Medications. Kidney Int Rep 2023; 8:2818-2821. [PMID: 38106590 PMCID: PMC10719591 DOI: 10.1016/j.ekir.2023.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 12/19/2023] Open
Affiliation(s)
- Hanad Osman
- Diabetes Research Centre, Department of Population Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Dan Lane
- Department of Metabolic Medicine and Chemical Pathology University Hospitals of Leicester NHS Trust, Leicester, UK
- Leicester van Geest Multi-Omics Facility, Hodgkin Building, University of Leicester, Leicester, UK
| | - Dennis Bernieh
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, UK
| | - Samuel Seidu
- Diabetes Research Centre, Department of Population Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Prashanth Patel
- Department of Metabolic Medicine and Chemical Pathology University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, Department of Population Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
- NIHR Applied Research Collaboration East Midlands, Leicester General Hospital, Leicester, UK
| | - Nigel J. Brunskill
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- John Walls Renal Unit, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Gang Xu
- John Walls Renal Unit, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Pankaj Gupta
- Department of Metabolic Medicine and Chemical Pathology University Hospitals of Leicester NHS Trust, Leicester, UK
- Leicester van Geest Multi-Omics Facility, Hodgkin Building, University of Leicester, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
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