Abstract
Stroke is sometimes seen in patients with congestive heart failure (CHF). The factors that best predict incident stroke in hospitalized CHF patients are not well known. We performed this pilot study to explore the clinical markers of incident stroke in CHF patients. We studied 111 hospitalized patients with CHF (mean age, 67±11 years). Ambulatory blood pressure (BP) monitoring, blood tests, and echocardiography were performed in these patients just before they left the hospital, and all cardiovascular events during the study period were followed for an average of 18±9 months. Cox regression analysis was performed to explore the predictors of incident stroke using age, sex, body mass index (BMI), casual and ambulatory systolic BP (SBP), and brain-type natriuretic peptide (BNP). There were 10 stroke events (9%) during the follow-up period. The stroke group had higher nocturnal SBP and plasma BNP levels than the non-stroke group. With Cox regression analysis, both nocturnal SBP and BNP were significant predictors of incident stroke independent of other covariates. When nocturnal BP of 120 mmHg and BNP of 600 pg/mL (75th percentile) were used as cutoffs, nocturnal SBP ≥120 mmHg was associated with a 7-fold increase in the risk of incident stroke, while BNP ≥600 pg/mL was associated with a 46.6-fold increase. However, abnormal circadian BP patterns were not associated with incident stroke. In this pilot study, elevated nocturnal BP and high plasma BNP just before patients left the hospital were significant predictors of stroke events in CHF patients. Further study is needed to confirm this hypothesis.
Similar content being viewed by others
Article PDF
References
Rosamond W, Flegal K, Friday G, et al: Heart disease and stroke statistics—2007 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2007; 115: e69–e171.
McCullough PA, Philbin EF, Spertus JA, Kaatz S, Sandberg KR, Weaver WD : Confirmation of a heart failure epidemic: findings from the Resource Utilization Among Congestive Heart Failure (REACH) study. J Am Coll Cardiol 2002; 39: 60–69.
Levy D, Kenchaiah S, Larson MG, et al: Long-term trends in the incidence of and survival with heart failure. N Engl J Med 2002; 347: 1397–1402.
Siachos T, Vanbakel A, Feldman DS, Uber W, Simpson KN, Pereira NL : Silent strokes in patients with heart failure. J Card Fail 2005; 11: 485–489.
Pullicino PM, Halperin JL, Thompson JL : Stroke in patients with heart failure and reduced left ventricular ejection fraction. Neurology 2000; 54: 288–294.
Wilhelmsen L, Rosengren A, Eriksson H, Lappas G : Heart failure in the general population of men—morbidity, risk factors and prognosis. J Intern Med 2001; 249: 253–261.
Goldstein LB, Adams R, Alberts MJ, et al: Primary prevention of ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council: cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: the American Academy of Neurology affirms the value of this guideline. Stroke 2006; 37: 1583–1633.
Koniaris L, Goldhaber S : Anticoagulation in dilated cardiomyopathy. J Am Coll Cardiol 1998; 31: 745–748.
Freudenberger RS, Massie BM : Silent cerebral infarction in heart failure: vascular or thromboembolic? J Card Fail 2005; 11: 490–491.
Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 1997; 20: 1183–1197.
Sokolow M, Lyon TP : The ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial and limb leads. Am Heart J 1949; 37: 161–186.
Imai Y, Sasaki S, Minami N, et al: The accuracy and performance of the A&D TM 2421, a new ambulatory blood pressure monitoring device based on the cuff-oscillometric method and the Korotkoff sound technique. Am J Hypertens 1992; 5: 719–726.
Teichholz LE, Kreulen T, Herman MV, Gorlin R : Problems in echocardiographic volume determinations: echocardiographic-angiographic correlations in the presence of absence of asynergy. Am J Cardiol 1976; 37: 7–11.
Pickering TG, Hall JE, Appel LJ, et al: Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Circulation 2005; 111: 697–716.
Staessen JA, Asmar R, De Buyzere M, et al: Task Force II: blood pressure measurement and cardiovascular outcome. Blood Press Monit 2001; 6: 355–370.
Chobanian AV, Bakris GL, Black HR, et al: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289: 2560–2572.
Kizer JR, Wiebers DO, Whisnant JP, et al: Mitral annular calcification, aortic valve sclerosis, and incident stroke in adults free of clinical cardiovascular disease: the Strong Heart Study. Stroke 2005; 36: 2533–2537.
Lee TT, Chen J, Cohen DJ, Tsao L : The association between blood pressure and mortality in patients with heart failure. Am Heart J 2006; 151: 76–83.
Canesin MF, Giorgi D, Oliveira MT Jr, et al: Ambulatory blood pressure monitoring of patients with heart failure. A new prognosis marker. Arq Bras Cardiol 2002; 78: 83–89.
Goyal D, Macfadyen RJ, Watson RD, Lip GY : Ambulatory blood pressure monitoring in heart failure: a systematic review. Eur J Heart Fail 2005; 7: 149–156.
Kario K, Pickering TG, Matsuo T, Hoshide S, Schwartz JE, Shimada K : Stroke prognosis and abnormal nocturnal blood pressure falls in older hypertensives. Hypertension 2001; 38: 852–857.
Ohkubo T, Imai Y, Tsuji I, et al: Relation between nocturnal decline in blood pressure and mortality. The Ohasama Study. Am J Hypertens 1997; 10: 1201–1207.
Kario K, Matsuo T, Kobayashi H, Imiya M, Matsuo M, Shimada K : Nocturnal fall of blood pressure and silent cerebrovascular damage in elderly hypertensive patients. Advanced silent cerebrovascular damage in extreme dippers. Hypertension 1996; 27: 130–135.
Verdecchia P, Schillaci G, Borgioni C, et al: Altered circadian blood pressure profile and prognosis. Blood Press Monit 1997; 2: 347–352.
Hoshide S, Ishikawa J, Eguchi K, Ojima T, Shimada K, Kario K : Masked nocturnal hypertension and target organ damage in hypertensives with well-controlled self-measured home blood pressure. Hypertens Res 2007; 30: 143–149.
Nakano S, Ito T, Furuya K, et al: Ambulatory blood pressure level rather than dipper/nondipper status predicts vascular events in type 2 diabetic subjects. Hypertens Res 2004; 27: 647–656.
Eto M, Toba K, Akishita M, et al: Impact of blood pressure variability on cardiovascular events in elderly patients with hypertension. Hypertens Res 2005; 28: 1–7.
Doust JA, Pietrzak E, Dobson A, Glasziou P : How well does B-type natriuretic peptide predict death and cardiac events in patients with heart failure: systematic review. BMJ 2005; 330: 625.
Dries DL, Rosenberg YD, Waclawiw MA, Domanski MJ : Ejection fraction and risk of thromboembolic events in patients with systolic dysfunction and sinus rhythm: evidence for gender differences in the studies of left ventricular dysfunction trials. J Am Coll Cardiol 1997; 29: 1074–1080.
Sanderson JE : Heart failure with a normal ejection fraction. Heart 2007; 93: 155–158.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Komori, T., Eguchi, K., Tomizawa, H. et al. Factors Associated with Incident Ischemic Stroke in Hospitalized Heart Failure Patients: A Pilot Study. Hypertens Res 31, 289–294 (2008). https://doi.org/10.1291/hypres.31.289
Received:
Accepted:
Issue date:
DOI: https://doi.org/10.1291/hypres.31.289
Keywords
This article is cited by
-
Perfect 24-h management of hypertension: clinical relevance and perspectives
Journal of Human Hypertension (2017)
