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Lower stroke risk with lower blood pressure in hemodynamic cerebral ischemia

William J Powers1, William R Clarke, Robert L Grubb

  • 1From the Department of Neurology (W.J.P.), University of North Carolina School of Medicine, Chapel Hill; Clinical Trials Statistics and Data Management Center (W.R.C.), University of Iowa College of Public Health, Iowa City; Departments of Neurological Surgery (R.L.G., C.P.D.), Radiology (R.L.G., T.O.V., C.P.D.), and Neurology (T.O.V., C.P.D.), Washington University School of Medicine, St. Louis, MO; and the Department of Neurology (H.P.A.), University of Iowa Carver School of Medicine, Iowa City.

Neurology
|February 18, 2014
PubMed

Insights

Strict blood pressure control (≤130/85 mm Hg) significantly lowers stroke risk in patients with symptomatic carotid artery occlusion and hemodynamic cerebral ischemia. This finding supports hypertension management in this patient group.

Area of Science:

  • Neurology
  • Vascular Medicine
  • Cardiology

Background:

  • Symptomatic carotid artery occlusion with hemodynamic cerebral ischemia poses a significant stroke risk.
  • Optimal medical management, particularly blood pressure control, is crucial for these patients.

Purpose of the Study:

  • To evaluate if strict blood pressure (BP) control (≤130/85 mm Hg) is superior medical management for patients with symptomatic carotid artery occlusion and hemodynamic cerebral ischemia.
  • To assess the association between BP control and subsequent ipsilateral ischemic stroke risk.

Main Methods:

  • Prospective observational cohort study of 91 patients from the Carotid Occlusion Surgery Study (COSS) nonsurgical group.
  • Patients had recent symptomatic internal carotid artery occlusion and hemodynamic cerebral ischemia (increased oxygen extraction fraction).
  • Comparison of stroke occurrence between patients with mean BP ≤130/85 mm Hg and those with BP >130/85 mm Hg.

Main Results:

  • A total of 16 ipsilateral ischemic strokes occurred during follow-up.
  • 3 strokes occurred in the 41 patients with BP ≤130/85 mm Hg.
  • 13 strokes occurred in the 50 patients with BP >130/85 mm Hg (HR 3.742, p = 0.027).

Conclusions:

  • Blood pressure control to ≤130/85 mm Hg is associated with a reduced risk of subsequent ipsilateral ischemic stroke.
  • This study provides Class III evidence supporting strict hypertension management in patients with symptomatic carotid occlusion and hemodynamic cerebral ischemia.
Abstract

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