Higher Stroke Risk with Lower Blood Pressure in Hemodynamic Vertebrobasilar Disease: Analysis from the VERiTAS Study
| Autor: | Colin P. Derdeyn, Philip B. Gorelick, Xinjian Du, Fady T. Charbel, Dilip K. Pandey, Mitchell S.V. Elkind, David S Liebeskind, Frank L. Silver, Tanya N. Turan, Scott E. Kasner, Gregory J. Zipfel, Sepideh Amin-Hanjani, DeJuran Richardson, Linda Rose-Finnell |
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| Rok vydání: | 2017 |
| Předmět: |
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medicine.medical_specialty Hemodynamics Blood Pressure Constriction Pathologic Disease 030204 cardiovascular system & hematology Severity of Illness Index Article Magnetic resonance angiography 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine Occlusion Vertebrobasilar Insufficiency medicine Humans Prospective Studies Stroke Aged medicine.diagnostic_test business.industry Rehabilitation Brain Blood flow Middle Aged medicine.disease Cerebral Angiography Surgery Blood pressure Ischemic Attack Transient Cardiology Female Neurology (clinical) Cardiology and Cardiovascular Medicine business Perfusion Magnetic Resonance Angiography 030217 neurology & neurosurgery Follow-Up Studies |
| Zdroj: | Journal of Stroke and Cerebrovascular Diseases. 26:403-410 |
| ISSN: | 1052-3057 |
| Popis: | Despite concerns regarding hypoperfusion in patients with large-artery occlusive disease, strict blood pressure (BP) control has become adopted as a safe strategy for risk reduction of stroke. We examined the relationship between BP control, blood flow, and risk of subsequent stroke in the prospective Vertebrobasilar Flow Evaluation and Risk of Transient Ischemic Attack and Stroke (VERiTAS) study.The VERiTAS study enrolled patients with recent vertebrobasilar (VB) transient ischemic attack or stroke and ≥50% atherosclerotic stenosis or occlusion of vertebral or basilar arteries. Hemodynamic status was designated as low or normal based on quantitative magnetic resonance angiography. Patients underwent standard medical management and follow-up for primary outcome event of VB territory stroke. Mean BP during follow-up (140/90 versus ≥140/90 mm Hg) and flow status were examined relative to subsequent stroke risk using Cox proportional hazards analysis.The 72 subjects had an average of 3.8 ± 1.2 BP recordings over 20 ± 8 months of follow-up; 39 (54%) had mean BP of140/90 mm Hg. The BP groups were largely comparable for baseline demographics, risk factors, and stenosis severity. Comparing subgroups stratified by BP and hemodynamic status, we found that patients with both low flow and BP140/90 mm Hg (n = 10) had the highest risk of subsequent stroke, with hazard ratio of 4.5 (confidence interval 1.3-16.0, P = .02), compared with the other subgroups combined.Among a subgroup of patients with VB disease and low flow, strict BP control (BP140/90) may increase the risk of subsequent stroke. |
| Databáze: | OpenAIRE |
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