What is it about?
Our previous studies showed a higher stroke risk and lower systolic blood pressure (< 130mmHg) in patients with atherosclerotic internal carotid artery or middle cerebral artery occlusive disease. Lower blood pressure might reduce blood flow in the collateral pathways, thereby impairing the growth of cerebral collaterals, inhibiting hemodynamic improvement, and leading to a higher stroke risk. This study showed the lower systolic blood pressure was associated with lesser hemodynamic improvement in patients with internal carotid artery or middle cerebral artery occlusive disease.
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Why is it important?
Medical treatments to promote collaterals may play an important role in preventing ischemic stroke by improving hemodynamics in patients with major cerebral artery occlusive disease. The results of the present study suggest that controlling the BP may be important for hemodynamic improvement. We do not recommend an aggressive control of SBP (< 130 mm Hg) in patients with atherosclerotic ICA or MCA disease, especially in patients with impaired perfusion. We suggest that the lower limit of BP control should be individualized based on the presence of impaired perfusion. Avoiding aggressive SBP control (<130 mm Hg) may be best to prevent hemodynamic deterioration in patients with impaired perfusion.
Perspectives
A randomized, controlled trial including direct hemodynamic measurement is needed to determine the level to which BP should be lowered to achieve maximal benefits in hemodynamic improvement or reduced stroke risk in patients with or without impaired perfusion.
Hiroshi Yamauchi
Shiga Medical Center Research Institute
Read the Original
This page is a summary of: Long-term hemodynamic changes and blood pressure in atherosclerotic major cerebral artery disease, Journal of Cerebral Blood Flow & Metabolism, August 2017, SAGE Publications,
DOI: 10.1177/0271678x17727385.
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