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Blood pressure reduction in hypertensive acute ischemic stroke patients does not affect cerebral blood flow.

ABSTRACT: The effect of blood pressure (BP) reduction on cerebral blood flow (CBF) in acute ischemic stroke is unknown. We measured regional CBF with perfusion-weighted MRI before and after BP treatment in a three-armed non-randomized prospective controlled trial. Treatment arm assignment was based on acute mean arterial pressure (MAP). Patients with (MAP) >120?mmHg (n?=?14) were treated with intravenous labetalol and sublingual (SL) nitroglycerin (labetalol group). Those with MAP 100-120?mmHg (n?=?17) were treated with SL nitroglycerin (0.3?mg) ('NTG Group') and those with baseline MAP<100?mmHg (n?=?18) were not treated with antihypertensive drugs (untreated group). Forty-nine patients (18 female, mean age 65.3?±?12.9 years) were serially imaged. Labetalol reduced MAP by 12.5 (5.7-17.7)?mmHg, p?=?0.0002. MAP remained stable in the NTG (6.0 (0.4-16, p?=?0.3)?mmHg and untreated groups (-0.3 (-2.3-7.0, p?=?0.2)?mmHg. The volume of total hypoperfused tissue (CBF<18?ml/100?g/min) did not increase after labetalol (-1.1 ((-6.5)-(-0.2)) ml, p?=?0.1), NTG (0 ((-1.5)-4.5) ml, p?=?0.72), or no treatment 0.25 ((-10.1)-4.5) ml, p?=?0.87). Antihypertensive therapy, based on presenting BP, in acute stroke patients was not associated with an increased volume of total hypoperfused tissue.

SUBMITTER: Kate M

PROVIDER: S-EPMC6727146 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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Blood pressure reduction in hypertensive acute ischemic stroke patients does not affect cerebral blood flow.

Kate Mahesh M Asdaghi Negar N Gioia Laura C LC Buck Brian B Majumdar Sumit R SR Jeerakathil Thomas T Shuaib Ashfaq A Emery Derek D Beaulieu Christian C Butcher Kenneth K

Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism 20180508 9

The effect of blood pressure (BP) reduction on cerebral blood flow (CBF) in acute ischemic stroke is unknown. We measured regional CBF with perfusion-weighted MRI before and after BP treatment in a three-armed non-randomized prospective controlled trial. Treatment arm assignment was based on acute mean arterial pressure (MAP). Patients with (MAP) >120 mmHg (<i>n</i> = 14) were treated with intravenous labetalol and sublingual (SL) nitroglycerin (labetalol group). Those with MAP 100-120 mmHg (<i> ...[more]

PMID: 29737226

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Project description:BackgroundClinical trials have generally showed a neutral effect of blood pressure (BP) reduction on clinical outcomes among acute ischemic stroke patients. We conducted a prespecified subgroup analysis to assess whether disease severity modifies the effect of early antihypertensive treatment on death and disability among patients with acute ischemic stroke.MethodsIn the China Antihypertensive Trial in Acute Ischemic Stroke, 4,071 patients with acute ischemic stroke and elevated BP were randomly assigned to receive antihypertensive treatment or to discontinue all hypertension medications within 48 h of symptom onset. The primary outcome was a combination of death and major disability at 14 days or hospital discharge. In this subgroup analysis, participants were categorized into 3 groups according to their baseline NIH Stroke Scale (NIHSS) scores (0-4, 5-15, or ≥16).ResultsAt 24 h after randomization, mean systolic BP differences (95% CIs) were -8.5 (-10.0 to -7.1), -9.8 (-11.4 to -8.3), and -9.1 (-14.4 to -3.8) mm Hg between the treatment and control groups (all p values <0.001) for patients with a baseline NIHSS score of 0-4, 5-15, and ≥16, respectively. At day 7 after randomization, the corresponding mean systolic BP differences were -9.3 (-10.5 to -8.2), -9.1 (-10.3 to -7.8), and -10.1 (-15.1 to -5.1) mm Hg between the treatment and control groups (all p values <0.001). The primary outcome was not significantly different between the treatment and control groups at day 14 or hospital discharge among all NIHSS subgroups (p value for homogeneity = 0.66). ORs (95% CI) associated with treatment were 1.14 (0.87-1.49, p = 0.33), 1.04 (0.86-1.25, p = 0.70), and 0.67 (0.18-2.44, p = 0.54) for patients with a baseline NIHSS score of 0-4, 5-15, and ≥16, respectively. The composite outcome of death and major disability at 3-month follow-up did not differ between the 2 comparison groups for all NIHSS subgroups. In addition, vascular events and recurrent stroke were not significantly different between the 2 comparison groups at the 3-month follow-up visit among all NIHSS subgroups except that there was a suggestive risk reduction for recurrent stroke among those with an NIHSS score of 5-15 (OR 0.45, 95% CI 0.20-0.99, p = 0.05).ConclusionEarly BP reduction with antihypertensive medications did not reduce or increase the risk of death, major disabilities, recurrent instances of stroke, and vascular events in acute ischemic stroke patients with a variety of disease severities.

Dataset Information

Blood pressure reduction in hypertensive acute ischemic stroke patients does not affect cerebral blood flow.

Publications

Blood pressure reduction in hypertensive acute ischemic stroke patients does not affect cerebral blood flow.

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