Journal article
Age-specific cerebral haemodynamic effects of early blood pressure lowering after TIA and non-disabling stroke
- Abstract:
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INTRODUCTION: 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.
PATIENTS AND METHODS: 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).
RESULTS: 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).
CONCLUSION: 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.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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(Preview, Version of record, pdf, 749.9KB, Terms of use)
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- Publisher copy:
- 10.1177/23969873211039716
Authors
- Publisher:
- SAGE Publications
- Journal:
- European Stroke Journal More from this journal
- Volume:
- 6
- Issue:
- 3
- Pages:
- 245-253
- Publication date:
- 2021-09-04
- Acceptance date:
- 2021-07-15
- DOI:
- EISSN:
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2396-9881
- ISSN:
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2396-9873
- Language:
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English
- Keywords:
- Pubs id:
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1188111
- Local pid:
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pubs:1188111
- Deposit date:
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2021-07-29
- ARK identifier:
Terms of use
- Copyright holder:
- European Stroke Organisation
- Copyright date:
- 2021
- Rights statement:
- © European Stroke Organisation 2021. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).
- Licence:
- CC Attribution (CC BY)
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