Optimal blood pressure target for patients with prior stroke: A systematic review and meta-analysis
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Blood pressure management to prevent recurrent stroke: current evidence and perspectives
Hypertension is the leading risk factor for stroke, causing about 60% of cases. Effective blood pressure control is vital for preventing recurrent ischemic strokes, with studies showing mixed results. Intensive control reduces cardiovascular events, as seen in the SPRINT, PROGRESS and STEP studies, while trials like RESPECT show no difference. Technological advances like AI and wearables enhance management, but challenges remain in achieving equitable control, especially for minorities.
Early vascular aging ambulatory score in acute ischemic stroke
Understanding the impact of early vascular aging (EVA) on acute ischemic stroke (AIS) outcomes may provide new insights for improving prognostic assessments and developing targeted therapeutic strategies. This study aimed to validate the EVA ambulatory score (EVAAs) in AIS patients, assessing its association with stroke type, severity, and prognosis. Among the 2,730 AIS patients with a mean age of 72.0 ± 14.4 years, 83.4% exhibited EVA. EVA was identified as an independent predictor of poor outcome at both discharges (aOR:1.72, 95%CI:1.25–2.36, p < 0.001) and at 90 days (aOR:2.22, 95%CI:1.49–3.31, p < 0.001). In subgroup analyses, EVAAs showed improved predictive value in AIS patients with a lower cardiovascular disease burden and a non-atherogenic lipid profile. The EVAAs, as an indicator of EVA that could be easily integrated into daily clinical practice, are a significant predictor of adverse outcomes in AIS patients.
Stroke-induced neuroplasticity in spiny mice in the absence of tissue regeneration
Stroke is a major cause of disability for adults over 40 years of age. While research into animal models has prioritized treatments aimed at diminishing post-stroke damage, no studies have investigated the response to a severe stroke injury in a highly regenerative adult mammal. Here we investigate the effects of transient ischemia on adult spiny mice, Acomys cahirinus, due to their ability to regenerate multiple tissues without scarring. Transient middle cerebral artery occlusion was performed and Acomys showed rapid behavioral recovery post-stroke yet failed to regenerate impacted brain regions. An Acomys brain atlas in combination with functional (f)MRI demonstrated recovery coincides with neuroplasticity. The strength and quality of the global connectome are preserved post-injury with distinct contralateral and ipsilateral brain regions compensating for lost tissue. Thus, we propose Acomys recovers functionally from an ischemic stroke injury not by tissue regeneration but by altering its brain connectome.
Blood pressure elevations post-lenvatinib treatment in hepatocellular carcinoma: a potential marker for better prognosis
Lenvatinib is a tyrosine kinase inhibitor that effectively inhibits vascular endothelial growth factor signaling and is used for treating hepatocellular carcinoma. However, angiogenesis inhibitors often cause hypertension. Although lenvatinib-induced hypertension has been proposed as a potential surrogate marker for better prognosis, studies on blood pressure elevations and outcomes following lenvatinib initiation are limited. This study included 67 patients who underwent lenvatinib therapy at the Department of Gastroenterology, Kagoshima University Hospital, between May 2018 and December 2023. The median age of the cohort was 71 years, and 82.1% of the patients were male. The median blood pressure at admission was 128/73 mmHg, which significantly increased to 136/76 mmHg the day after lenvatinib administration. Grade 3 hypertension (≥160/100 mmHg) occurred in 37.3% of patients during hospitalization. The median increase in systolic blood pressure from admission to its peak during hospitalization was 26 mmHg. Patients who experienced an increase in blood pressure of ≥26 mmHg were classified into the blood pressure elevation group, which showed a significantly lower mortality rate than that of the blood pressure non-elevation group (35.3% vs. 81.8%, log-rank p = 0.007), even after adjusting for age, sex, disease stage, performance status, and liver reserve function. This study demonstrated that patients who experienced earlier blood pressure elevation after lenvatinib administration had lower overall mortality rates. These findings suggest that blood pressure elevations after lenvatinib initiation may serve as valuable prognostic indicators in patients with cancer undergoing lenvatinib therapy.
Weekend sedentary behaviour and cognition three months after stroke based on the exploratory analysis of the CANVAS study
Stroke survivors experience high levels of sedentary behaviour. However, less is known about the variability in weekday-weekend patterns of sedentary behaviour and whether it is linked to cognitive performance. We examined whether there was a difference in weekend and weekday amount of time spent in sedentary and moderate-to-vigorous physical activity (MVPA) at three months post-stroke and whether there was an association between these patterns and cognitive performance at three months. We included ischaemic stroke survivors from the Cognition And Neocortical Volume After Stroke (CANVAS) cohort, with objective physical activity data estimated using the SenseWear® Armband. We compared physical activity levels between 97 stroke survivors (minor severity) and 37 control participants on weekends and weekdays in sedentary and MVPA zones. We then linked these outcomes to cognitive functioning at three months. While both stroke and control groups had a comparable decrease in MVPA on weekends compared to weekdays, we observed a significant increase in sedentary activity [55 min on average (95% Confidence Interval 77 − 33) with a small effect size – partial eta squared = 0.036)] on weekends in the stroke group but not in controls. When we compared two groups of stroke participants ‘more sedentary’ vs. ‘less sedentary’—based on weekend activity, we observed a higher proportion of stroke survivors classified as cognitively impaired vs. cognitively normal in the ‘more sedentary’ group. Further analysis showed the groups differed significantly on their cognitive performance, especially in the memory domain. There is a significant difference in the amount of sedentary behaviour, but not MVPA, on weekends vs. weekdays in the stroke group. Furthermore, we demonstrate that a higher amount of sedentary activity on the weekend is associated with worse cognitive performance at three months, especially on memory tasks. These results are exploratory but suggest that decreasing sedentary behaviour, especially on the weekend, could be specifically investigated as a therapeutic target to maintain better cognition after stroke.
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