Background
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.
Methods
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.
Results
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 of<140/90 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 BP <140/90 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.
Conclusions
Among a subgroup of patients with VB disease and low flow, strict BP control (BP <140/90)
may increase the risk of subsequent stroke.
Key Words
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References
- Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2014; 45: 2160-2236
- Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2014; 45: 3754-3832
- Relationship between blood pressure and stroke risk in patients with symptomatic carotid occlusive disease.Stroke. 2003; 34: 2583-2590
- Relationship between blood pressure and stroke recurrence in patients with intracranial arterial stenosis.Circulation. 2007; 115: 2969-2975
- Lower stroke risk with lower blood pressure in hemodynamic cerebral ischemia.Neurology. 2014; 82: 1027-1032
- Vertebrobasilar Flow Evaluation and Risk of Transient Ischaemic Attack and Stroke study (VERiTAS): rationale and design.Int J Stroke. 2010; 5: 499-505
- Hemodynamic features of symptomatic vertebrobasilar disease.Stroke. 2015; 46: 1850-1856
- Effect of hemodynamics on stroke risk in symptomatic atherosclerotic vertebrobasilar occlusive disease.JAMA Neurol. 2016; 73: 178-185
- Use of quantitative magnetic resonance angiography to stratify stroke risk in symptomatic vertebrobasilar disease.Stroke. 2005; 36: 1140-1145
- Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.Hypertension. 2003; 42: 1206-1252
- New England Medical Center Posterior Circulation registry.Ann Neurol. 2004; 56: 389-398
- Lower target blood pressures are safe and effective for the prevention of recurrent stroke: the PROGRESS trial.J Hypertens. 2006; 24: 1201-1208
- A randomized trial of intensive versus standard blood-pressure control.N Engl J Med. 2015; 373: 2103-2116
- Collaterals dramatically alter stroke risk in intracranial atherosclerosis.Ann Neurol. 2011; 69: 963-974
- Extracranial-intracranial bypass surgery for stroke prevention in hemodynamic cerebral ischemia: the Carotid Occlusion Surgery Study randomized trial.JAMA. 2011; 306: 1983-1992
- Visit-to-visit variability of blood pressure and coronary heart disease, stroke, heart failure, and mortality: a cohort study.Ann Intern Med. 2015; 163: 329-338
Article info
Publication history
Published online: October 28, 2016
Accepted:
September 27,
2016
Received:
August 1,
2016
Footnotes
Grant support: The VERiTAS Study was funded by the National Institutes of Health/National Institute of Neurological Disorders and Stroke (R01 NS 059745) and the Dr Ralph and Marian Falk Research Trust Foundation. Other research support (no direct funds) provided by VasSol, Inc. (Supplying NOVA QMRA technology and technical support).
Conflicts of interest: S.A.-H.: received material research support (no direct funds) from GE Healthcare and VasSol, Inc. D.S.L.: consultant for Stryker, Medtronic. C.P.D.: consultant for Microvention, Silk Road, Penumbra; serves on the Scientific Advisory Board, Pulse Therapeutics; stock options in Pulse Therapeutics. P.B.G.: served as the founder and director/co-director of the Clinical Coordinating Center for the Lundbeck sponsored DIAS 4 trial of desmoteplase in acute ischemic stroke. F.T.C.: has financial interest in VasSol, Inc.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.09.044
Copyright
© 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.
