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Pathogenesis, diagnosis, and treatment of hypertension-associated stroke
1Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Insights
High blood pressure (hypertension) is a major risk factor for stroke, affecting cerebral vessels and potentially causing different stroke types. Aspirin can help reduce recurrent stroke incidence in patients with cerebral infarction.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Cerebrovascular Disease
Background:
- Chronically elevated blood pressure (hypertension) significantly predisposes individuals to stroke.
- Hypertension impacts both extracranial and intracranial cerebral vessels, leading to various cerebrovascular events.
- The precise role of hypertension in atherothromboembolic stroke requires further investigation, especially considering its impact on myocardial infarction prevention.
Purpose of the Study:
- To explore the multifaceted role of hypertension in the pathogenesis of different stroke types.
- To review the diagnostic approaches and current treatment limitations for stroke.
- To highlight potential therapeutic avenues for managing cerebral infarction and preventing recurrence.
Main Methods:
- Review of existing literature on hypertension and stroke.
- Analysis of the mechanisms linking hypertension to lacunar infarction, intracerebral hemorrhage, and atherothromboembolic stroke.
- Evaluation of diagnostic tools such as brain imaging and cerebral arteriography.
- Assessment of current and emerging treatment strategies for stroke.
Main Results:
- Hypertension-associated small vessel disease can lead to lacunar infarction or intracerebral hemorrhage.
- The association between hypertension and atherothromboembolic stroke is complex and may be overestimated.
- Atrial fibrillation in non-rheumatic heart disease patients is linked to hypertension, but stroke incidence from this cause might be overestimated.
- Aspirin has demonstrated efficacy in reducing stroke recurrence in patients with cerebral infarction.
Conclusions:
- Hypertension is a critical risk factor for stroke, influencing various pathological pathways.
- While diagnostic imaging is ideal, cerebral arteriography is not always indicated.
- Current treatments for completed strokes are limited, but tissue plasminogen activator, calcium-channel blockers, and aspirin show promise for specific conditions and recurrence prevention.
- Surgical decompression can be life-saving in cerebellar infarction or hemorrhage.
Abstract:
Chronically elevated blood pressure predisposes to stroke through effects on the extracranial and intracranial cerebral vessels. Hypertension-associated disease of small-diameter penetrating cerebral arteries may produce either lacunar infarction or intracerebral hemorrhage. The role of hypertension in the pathogenesis of atherothromboembolic cerebral infarction must be questioned in view of the evidence that antihypertensive therapy does not prevent myocardial infarction. Hypertension, in the absence of rheumatic heart disease, is frequently associated with atrial fibrillation. The incidence of stroke due to embolization of thrombus from the fibrillating left atrium of the nonrheumatic heart may have been overestimated in the past. Ideally, investigation of the patient who has had a stroke should include a brain-imaging study and a cerebral arteriogram. In practice, however, arteriography cannot always be justified. Treatment of the completed stroke is unsatisfactory but tissue plaminogen activator and calcium-channel blockers hold promise for cerebral infarction. Surgical decompression of the posterior fossa can be life-saving in cases of cerebellar infarction or hemorrhage. In patients with cerebral infarction, aspirin has been shown to reduce the incidence of stroke recurrence.