Format

Send to

Choose Destination
See comment in PubMed Commons below
J Neurol Neurosurg Psychiatry. 2013 Nov;84(11):1226-32. doi: 10.1136/jnnp-2013-305159. Epub 2013 Aug 9.

Impaired perfusion modifies the relationship between blood pressure and stroke risk in major cerebral artery disease.

Author information

1
Division of PET Imaging, Shiga Medical Centre Research Institute, , Shiga, Japan.

Erratum in

  • J Neurol Neurosurg Psychiatry. 2014 Jan;85(1):118.

Abstract

OBJECTIVE:

Blood pressure (BP) lowering may increase stroke risk in patients with symptomatic major cerebral artery disease and impaired perfusion. To investigate the relationships among BP, impaired perfusion and stroke risk.

METHODS:

We retrospectively analysed data from 130 non-disabled, medically treated patients with either symptomatic extracranial carotid occlusion or intracranial stenosis or occlusion of the carotid artery or middle cerebral arteries. All patients had baseline haemodynamic measurements with (15)O-gas positron emission tomography and were followed for 2 years or until stroke recurrence or death.

RESULTS:

There was a negative linear relationship between systolic BP (SBP) and risk of stroke in the territory of the diseased artery. The 2-year incidence of ischaemic stroke in the territory in patients with normal SBP (<130 mm Hg, 5/32 patients) was significantly higher than in patients with high SBP (2/98, p<0.005). Multivariate analysis revealed that normal SBP and impaired perfusion were independently associated with increased risk of stroke in the previously affected territory, while risk of stroke elsewhere was positively correlated with SBP. Overall, high total stroke risk was observed at lower BP in patients with impaired perfusion and at higher BPs in patients without (interaction, p<0.01). Overall, the relationship between SBP and total stroke recurrence was J-shaped.

CONCLUSIONS:

Impaired perfusion modified the relationship between blood pressure and stroke risk, although this study had limitations including the retrospective analysis, the potentially biased sample, the small number of critical events and the fact that BP was measured only as a snapshot in clinic.

KEYWORDS:

CEREBRAL BLOOD FLOW; PET; STROKE

PMID:
23933741
PMCID:
PMC3812848
DOI:
10.1136/jnnp-2013-305159
[Indexed for MEDLINE]
Free PMC Article
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for HighWire Icon for PubMed Central
    Loading ...
    Support Center