SERIAL CHANGES IN BLOOD-PRESSURE AND NEUROHORMONE LEVELS AFTER THE ONSET OF LACUNAR STROKE

To assess serial changes in blood pressure and its circadian variation following a lacunar stroke, the authors studied 7 patients who develo ped a single lacunar infarction in either the internal capsule or the corona radiata. Blood pressure and pulse rate were monitored noninvasi vely for twenty-four hours by an ambulatory blood pressure monitoring device in the acute, subacute, and chronic phases of the strokes. In t he acute and chronic phases, the authors also measured urinary excreti on of catecholamines every 6 hr, and serum cortisol concentration at 9 :00, 17:00, and 21:00 hr. The patients were free from antihypertensive agents during the study. The twenty-four-hour averages of both systol ic and diastolic blood pressure in the chronic phase were lower than t hose in the acute phase (P < 0.05). A nighttime fall in blood pressure was observed in the subacute and chronic phases (P < 0.05), but not i n the acute phase. Urinary excretion of epinephrine at night in the ac ute phase was significantly higher than that in the chronic phase (P < 0.05). Serum levels of cortisol at 17:00 and 21:00 hr in the acute ph ase also exceeded those in the chronic phase (P < 0.05 and P < 0.01, r espectively). The authors conclude that an increased secretion of epin ephrine and cortisol might, at least in part, contribute to a high blo od pressure and a lack of circadian variation in blood pressure in the acute phase of lacunar stroke.