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Blood Pressure Control for Patients with Middle Cerebral Artery Severe Stenosis or Occlusion

Zheng Li1,2, Guang-Xin Duan3, Jia-Hui Zhang3

  • 1Department of Rehabilitation, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, People's Republic of China.

Clinical Interventions in Aging
|November 25, 2024
PubMed

Insights

Chronic hypertension may impair cerebral perfusion. Tightly controlling blood pressure below 140/80mmHg in patients with intracranial stenosis could further reduce ipsilateral cerebral perfusion.

Area of Science:

  • Neurology
  • Cardiovascular Medicine
  • Medical Imaging

Background:

  • Chronic hypertension is a known risk factor for ischemic stroke and poorer outcomes.
  • Optimal blood pressure targets for hypertensive individuals with severe intracranial stenosis remain debated.

Purpose of the Study:

  • To evaluate the impact of varying blood pressure levels on cerebral perfusion in patients experiencing severe stenosis or occlusion of the middle cerebral artery (MCA).

Main Methods:

  • 105 patients with isolated steno-occlusive MCA, confirmed by digital subtraction angiography (DSA), underwent perfusion-weighted imaging (PWI).
  • Risk factors were analyzed between hypertensive and non-hypertensive groups.
  • Multivariable logistic regression identified independent associations between hypertension and PWI values.
  • Cerebral perfusion was compared across different blood pressure levels.

Main Results:

  • Hypertensive patients exhibited lower cerebral perfusion pressure with increased relative mean transit time (rMTT) compared to non-hypertensive individuals.
  • Hypertension was independently associated with rMTT after adjusting for age, diabetes, and fibrinogen.
  • Significant differences in rMTT were noted in hypertensive patients with systolic blood pressure <140mmHg and diastolic blood pressure <80mmHg compared to non-hypertensives.

Conclusions:

  • Chronic hypertension may negatively affect cerebral perfusion.
  • Strict blood pressure control (<140/80mmHg) in hypertensive patients with intracranial artery stenosis might lead to a further reduction in ipsilateral cerebral perfusion.
Abstract

Keywords:
PWIblood pressure controlcerebral perfusionisolated severe steno-occlusive

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