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Published on: December 29, 2023
Cardiovascular medication seems to promote recovery of autonomic dysfunction after stroke
Ruihao Wang1, Martin Köhrmann2, Rainer Kollmar1,3
1Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany.
Insights
Cardiovascular-autonomic modulation (CAM) is compromised after stroke, but typically recovers within 3 months, even with medication. However, some dysfunction persists at 6 months, indicating ongoing autonomic vulnerability.
Area of Science:
- Neurology
- Cardiology
- Autonomic Neuroscience
Background:
- Stroke can impair cardiovascular-autonomic modulation (CAM).
- Previous studies on post-stroke CAM alterations excluded patients on cardiovascular medication.
- This study investigates CAM recovery in patients receiving typical clinical care, including medication.
Purpose of the Study:
- To evaluate the longitudinal changes in cardiovascular-autonomic modulation (CAM) after ischemic stroke.
- To determine if CAM dysfunction improves over several months in patients under typical clinical conditions.
- To assess the impact of cardiovascular medication on CAM recovery post-stroke.
Main Methods:
- 82 ischemic stroke patients and 30 healthy controls were studied.
- Cardiovascular medication use before and after stroke was recorded.
- Autonomic function tests measured parameters of total, sympathetic, and parasympathetic CAM, and baroreflex sensitivity at 1 week, 3 months, and 6 months post-stroke.
Main Results:
- Stroke patients initially showed impaired CAM and baroreflex sensitivity compared to controls.
- Significant CAM recovery was observed by 3 months, with some parameters returning to control levels.
- Despite recovery, some measures of CAM and baroreflex sensitivity remained lower in patients at 6 months.
Conclusions:
- Even mild ischemic strokes can compromise cardiovagal modulation and baroreflex sensitivity.
- CAM function largely recovers within 3 months post-stroke, potentially aided by cardiovascular medication.
- Persistent subtle CAM dysfunction at 6 months suggests continued autonomic vulnerability after stroke.
Background:
Stroke may compromise cardiovascular-autonomic modulation (CAM). The longitudinal post-stroke CAM alterations remain unclear as previous studies excluded patients with cardiovascular medication. This study evaluated whether CAM dysfunction improves after several months in patients under typical clinical conditions, i.e., without excluding patients with cardiovascular medication.
Methods:
In 82 ischemic stroke patients [33 women, 64.9 ± 8.9 years, NIHSS-scores 2 (interquartile range 1-5)], we evaluated the applications of cardiovascular medication before stroke, during autonomic tests performed within 1 week, 3 and 6 months after stroke onset. We determined resting RR intervals (RRI), systolic, diastolic blood pressures (BPsys), respiration, parameters reflecting total CAM [RRI-standard deviation (RRI-SD), RRI-total powers], sympathetic [RRI-low-frequency powers (RRI-LF), BPsys-LF powers] and parasympathetic CAM [RMSSD, RRI-high-frequency powers (RRI-HF powers)], and baroreflex sensitivity. ANOVA or Friedman tests with post hoc analyses compared patient data with data of 30 healthy controls, significance was assumed for P < 0.05.
Results:
More patients had antihypertensive medication after than before stroke. First-week CAM testing showed lower RRIs, RMSSD, RRI-SDs, RRI-total powers, RRI-HF powers, and baroreflex sensitivity, but higher BPsys-LF powers in patients than controls. After 3 and 6 months, patients had significantly higher RRIs, RRI-SDs, RRI-total powers, RMSSDs, RRI-HF powers, and baroreflex sensitivity, but lower BPsys-LF powers than in the 1st week; RMSSDs and RRI-HF powers no longer differed between patients and controls. However, 6-month values of RRIs, RRI-SDs, and baroreflex sensitivity were again lower in patients than controls.
Conclusions:
Even mild strokes compromised cardiovagal modulation and baroreflex sensitivity. After 3 months, CAM had almost completely recovered. Recovery might be related to the mild stroke severity. Presumably, CAM recovery was also promoted by the increased application of cardiovascular medication. Yet, slight CAM dysfunction after 6 months suggests continuing autonomic vulnerability.
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