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Relación entre la presión arterial y la recurrencia del accidente cerebrovascular en pacientes con estenosis arterial
Tanya N Turan1, George Cotsonis, Michael J Lynn
1Emory University, Atlanta, GA, USA. tturan@emory.edu
Circulation
|May 23, 2007
Resumen
La presión arterial más alta aumenta el riesgo de accidente cerebrovascular en pacientes con estenosis intracraneal. Este estudio desafía la práctica común de permitir la presión arterial alta para prevenir la hipoperfusión, lo que sugiere que en realidad puede elevar el riesgo de accidente cerebrovascular.
Área de la Ciencia:
- Neurología Neurología.
- Medicina Cardiovascular La medicina cardiovascular es una especialidad de la salud.
- Investigación del ictus Investigación del ictus.
Sus antecedentes:
- Los médicos a menudo mantienen la presión arterial alta en pacientes con estenosis intracraneal para prevenir la hipoperfusión.
- Se debate la eficacia de esta práctica en la reducción del riesgo de accidente cerebrovascular.
Objetivo del estudio:
- Para investigar la asociación entre la presión arterial alta y el riesgo de accidente cerebrovascular en pacientes con estenosis intracraneal.
- Para determinar si la presión arterial elevada protege contra o aumenta el riesgo de accidente cerebrovascular en esta población.
Principales métodos:
- Análisis de los datos de 567 pacientes en el ensayo de Warfarina-Aspirina para la Enfermedad Intracraneal Sintomática (WASID).
- Comparación del tiempo hasta el accidente cerebrovascular isquémico y el accidente cerebrovascular territorial basado en la presión arterial sistólica media (PMS) y la presión arterial diastólica media (PDD).
- Estratificación de los análisis por gravedad de la estenosis (moderada <70% vs. severa >=70%) y ubicación.
Principales resultados:
- El riesgo de accidente cerebrovascular isquémico aumentó significativamente con un promedio más alto de SBP y DBP, incluso después de ajustar por factores de riesgo.
- Los niveles elevados de SBP y DBP se asociaron con un mayor riesgo de accidente cerebrovascular dentro del territorio del vaso estenótico.
- Los pacientes con estenosis moderada mostraron un mayor riesgo de accidente cerebrovascular con SBP y DBP elevados; los pacientes con estenosis severa mostraron un mayor riesgo con DBP elevado.
Conclusiones:
- La presión arterial más alta está relacionada con un mayor riesgo de accidente cerebrovascular isquémico y accidente cerebrovascular territorial en pacientes con estenosis intracraneal.
- Estos hallazgos contradicen el enfoque clínico común de mantener la presión arterial alta en este grupo de pacientes.
- Los resultados sugieren fuertemente que la presión arterial elevada no debe mantenerse en pacientes con estenosis intracraneal.
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