Cerebral hemodynamic effects of early blood pressure lowering after TIA and stroke in patients with carotid stenosis
<p><strong>Background:</strong></p> Effects of early blood pressure (BP) lowering on cerebral perfusion in patients with moderate/severe occlusive carotid disease after transient ischemic attack (TIA) and non-disabling stroke are uncertain. <p><strong>Aims:</...
| Main Authors: | , , , , , , |
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| Other Authors: | |
| Format: | Journal article |
| Language: | English |
| Published: |
SAGE Publications
2022
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| _version_ | 1797108665455476736 |
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| author | Mazzucco, S Li, L McGurgan, IJ Assuncao Tuna, M Brunelli, N Binney, LE Rothwell, PM |
| author2 | Oxford Vascular Study Phenotyped cohort |
| author_facet | Oxford Vascular Study Phenotyped cohort Mazzucco, S Li, L McGurgan, IJ Assuncao Tuna, M Brunelli, N Binney, LE Rothwell, PM |
| author_sort | Mazzucco, S |
| collection | OXFORD |
| description | <p><strong>Background:</strong></p>
Effects of early blood pressure (BP) lowering on cerebral perfusion in patients with moderate/severe occlusive carotid disease after transient ischemic attack (TIA) and non-disabling stroke are uncertain.
<p><strong>Aims:</strong></p>
We aimed to evaluate the changes in transcranial Doppler (TCD) indices in patients undergoing blood pressure lowering soon after TIA/non-disabling stroke.
<p><strong>Methods:</strong></p>
Consecutive eligible patients (1 November 2011 to 30 October 2018) attending a rapid-access clinic with TIA/non-disabling stroke underwent telemetric home blood pressure monitoring (HBPM) for 1 month and middle cerebral artery velocities measurements ipsilateral to carotid stenosis on TCD ultrasound in the acute setting and at 1 month. Hypertensive patients (HBPM ⩾ 135/85) underwent intensive BP-lowering guided by HBPM unless they had bilateral severe occlusive disease (⩾ 70%). Changes in BP and TCD parameters were compared in patients with extracranial moderate/severe carotid stenosis (between 50% and occlusion) versus those with no or mild (< 50%) stenosis.
<p><strong>Results:</strong></p>
Of 764 patients with repeated TCD measures, 42 had moderate/severe extracranial carotid stenosis without bilateral severe occlusive disease. HBPM was reduced from baseline to 1 month in hypertensive patients both with versus without moderate/severe carotid stenosis (−12.44/15.99 vs −13.2/12.2 mmHg, respectively, p-difference = 0.82), and changes in TCD velocities (4.69/14.94 vs 2.69/13.86 cm/s, respectively, p-difference = 0.52 for peak systolic velocity and 0.33/7.06 vs 1.75/6.84 cm/s, p-difference = 0.34 for end-diastolic velocity) were also similar, with no evidence of greater hemodynamic compromise in patients with stenosis/occlusion.
<p><strong>Conclusion:</strong></p>
There was no evidence of worsening of TCD hemodynamic indices in patients with moderate/severe occlusive carotid disease treated with BP-lowering soon after TIA/non-disabling stroke, suggesting that antihypertensive treatment in this group of patients is safe in the acute setting of TIA clinics. |
| first_indexed | 2024-03-07T07:31:50Z |
| format | Journal article |
| id | oxford-uuid:643c9d53-ad88-413b-b62f-e22290c158ad |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T07:31:50Z |
| publishDate | 2022 |
| publisher | SAGE Publications |
| record_format | dspace |
| spelling | oxford-uuid:643c9d53-ad88-413b-b62f-e22290c158ad2023-01-27T08:54:42ZCerebral hemodynamic effects of early blood pressure lowering after TIA and stroke in patients with carotid stenosisJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:643c9d53-ad88-413b-b62f-e22290c158adEnglishSymplectic ElementsSAGE Publications 2022Mazzucco, SLi, LMcGurgan, IJAssuncao Tuna, MBrunelli, NBinney, LERothwell, PMOxford Vascular Study Phenotyped cohort<p><strong>Background:</strong></p> Effects of early blood pressure (BP) lowering on cerebral perfusion in patients with moderate/severe occlusive carotid disease after transient ischemic attack (TIA) and non-disabling stroke are uncertain. <p><strong>Aims:</strong></p> We aimed to evaluate the changes in transcranial Doppler (TCD) indices in patients undergoing blood pressure lowering soon after TIA/non-disabling stroke. <p><strong>Methods:</strong></p> Consecutive eligible patients (1 November 2011 to 30 October 2018) attending a rapid-access clinic with TIA/non-disabling stroke underwent telemetric home blood pressure monitoring (HBPM) for 1 month and middle cerebral artery velocities measurements ipsilateral to carotid stenosis on TCD ultrasound in the acute setting and at 1 month. Hypertensive patients (HBPM ⩾ 135/85) underwent intensive BP-lowering guided by HBPM unless they had bilateral severe occlusive disease (⩾ 70%). Changes in BP and TCD parameters were compared in patients with extracranial moderate/severe carotid stenosis (between 50% and occlusion) versus those with no or mild (< 50%) stenosis. <p><strong>Results:</strong></p> Of 764 patients with repeated TCD measures, 42 had moderate/severe extracranial carotid stenosis without bilateral severe occlusive disease. HBPM was reduced from baseline to 1 month in hypertensive patients both with versus without moderate/severe carotid stenosis (−12.44/15.99 vs −13.2/12.2 mmHg, respectively, p-difference = 0.82), and changes in TCD velocities (4.69/14.94 vs 2.69/13.86 cm/s, respectively, p-difference = 0.52 for peak systolic velocity and 0.33/7.06 vs 1.75/6.84 cm/s, p-difference = 0.34 for end-diastolic velocity) were also similar, with no evidence of greater hemodynamic compromise in patients with stenosis/occlusion. <p><strong>Conclusion:</strong></p> There was no evidence of worsening of TCD hemodynamic indices in patients with moderate/severe occlusive carotid disease treated with BP-lowering soon after TIA/non-disabling stroke, suggesting that antihypertensive treatment in this group of patients is safe in the acute setting of TIA clinics. |
| spellingShingle | Mazzucco, S Li, L McGurgan, IJ Assuncao Tuna, M Brunelli, N Binney, LE Rothwell, PM Cerebral hemodynamic effects of early blood pressure lowering after TIA and stroke in patients with carotid stenosis |
| title | Cerebral hemodynamic effects of early blood pressure lowering after TIA and stroke in patients with carotid stenosis |
| title_full | Cerebral hemodynamic effects of early blood pressure lowering after TIA and stroke in patients with carotid stenosis |
| title_fullStr | Cerebral hemodynamic effects of early blood pressure lowering after TIA and stroke in patients with carotid stenosis |
| title_full_unstemmed | Cerebral hemodynamic effects of early blood pressure lowering after TIA and stroke in patients with carotid stenosis |
| title_short | Cerebral hemodynamic effects of early blood pressure lowering after TIA and stroke in patients with carotid stenosis |
| title_sort | cerebral hemodynamic effects of early blood pressure lowering after tia and stroke in patients with carotid stenosis |
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