| Sumario: | <p><strong>INTRODUCTION:</strong> There is limited knowledge of the effects of blood pressure (BP) lowering on cerebral
haemodynamics after transient ischaemic attack (TIA) and non-disabling stroke, particularly at older
ages. We aimed to evaluate changes in transcranial Doppler (TCD) hemodynamic indices in patients
undergoing early blood pressure lowering after TIA/non-disabling stroke, irrespective of age.</p>
<p><strong>PATIENTS AND METHODS:</strong> Among consecutive eligible patients attending a rapid-access clinic with
suspected TIA/non-disabling stroke and no evidence of extra/intracranial stenosis, hypertensive ones
underwent intensive BP-lowering guided by daily home telemetric blood pressure monitoring (HBPM).
Clinic-based BP, HBPM, End-tidal CO2 and bilateral middle cerebral artery (MCA) velocity on TCD were
compared in the acute setting versus one-month follow-up; changes were stratified by baseline
hypertension (clinic-BP≥140/90) and by age (<65, 65-79 and ≥80).</p>
<p><strong>RESULTS:</strong> In 697 patients with repeated TCD measures, mean/SD baseline systolic-BP
(145.0/21.3mmHg) was reduced by an average of 11.3/19.9mmHg (p<0.0001) at one-month
(133.7/17.4mmHg), driven by patients hypertensive at baseline (systolic-BP change= -19.0/19.2 mmHg,
p<0.001; vs -0.5/15.4, p=0.62 in normotensives). Compared with baseline, a significant change was
observed at one-month only in mean/SD MCA EDV (0.77/7.26cm/s, p=0.005) and in RI (-0.005/0.051,
p=0.016), driven by hypertensive patients (mean/SD EDV change: 1.145/6.96cm/s p=0.001, RI change
-0.007/0.06, p=0.014). Findings were similar at all ages (EDV change – ptrend=0.357; RI change –
ptrend=0.225), including 117 patients aged ≥80. EDV and RI changes were largest in 100 patients with
clinic systolic-BP decrease ≥30mmHg (mean/SD EDV change = 2.49/7.47cm/s, p=0.001; RI change -
0.024/0.063, p<0.0001).</p>
<p><strong>CONCLUSION:</strong> There was no evidence of worsening of TCD haemodynamic indices associated with
BP-lowering soon after TIA/non-disabling stroke, irrespective of age and degree of BP reduction. In fact,
EDV increase and RI decrease observed after treatment of hypertensive patients suggest a decrease in
distal vascular resistance.</p>
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