Relationship between blood pressure and stroke recurrence in patients with intracranial arterial stenosis

Tanya N. Turan, George Cotsonis, Michael J. Lynn, Seemant Chaturvedi, Marc Chimowitz

Research output: Contribution to journalArticle

98 Citations (Scopus)

Abstract

BACKGROUND - Many clinicians allow blood pressure to run high in patients with intracranial stenosis to protect against hypoperfusion. We sought to determine whether higher blood pressure decreases the risk of stroke in these patients. METHODS AND RESULTS - Data on 567 patients in the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial were analyzed. Time to ischemic stroke and stroke in the same territory of the stenotic vessel was compared in patients grouped by mean systolic blood pressure (SBP) and mean diastolic blood pressure (DBP) during the study. Additional analyses were based on severity and location of stenosis. Ischemic stroke risk increased with increasing mean SBP and DBP on univariate analysis (P<0.0001, P<0.0001) and after adjustment for risk factors (P=0.0008, P<0.0001). Elevated mean SBP and DBP also resulted in increased risk of stroke in the territory in univariate (P=0.0065, P<0.0001) and adjusted (P=0.0002, P=0.0005) analyses. The increased risk of stroke with increasing SBP was driven largely by patients in the highest SBP group. Patients with moderate (<70%) stenosis had increased risk of stroke (P<0.0001, P=0.003) and stroke in the territory (P=0.0002, P=0.010) with increased SBP and DBP. Patients with severe (<70%) stenosis had increased risk of stroke and stroke in the territory with elevated DBP (P=0.004, P=0.004). CONCLUSIONS - In patients with intracranial stenosis, higher blood pressure is associated with increased (not decreased) risk of ischemic stroke and stroke in the territory of the stenotic vessel. These findings argue strongly against the common clinical practice of maintaining high blood pressure in patients with intracranial stenosis.

Original languageEnglish (US)
Pages (from-to)2969-2975
Number of pages7
JournalCirculation
Volume115
Issue number23
DOIs
StatePublished - Jun 2007
Externally publishedYes

Fingerprint

Pathologic Constriction
Stroke
Blood Pressure
Recurrence
Hypertension
Warfarin
Blood Group Antigens
Aspirin

Keywords

  • Blood pressure
  • Cerebral infarction
  • Cerebrovascular circulation
  • Hypertension
  • Intracranial arteriosclerosis
  • Prevention
  • Stenosis

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Relationship between blood pressure and stroke recurrence in patients with intracranial arterial stenosis. / Turan, Tanya N.; Cotsonis, George; Lynn, Michael J.; Chaturvedi, Seemant; Chimowitz, Marc.

In: Circulation, Vol. 115, No. 23, 06.2007, p. 2969-2975.

Research output: Contribution to journalArticle

Turan, Tanya N. ; Cotsonis, George ; Lynn, Michael J. ; Chaturvedi, Seemant ; Chimowitz, Marc. / Relationship between blood pressure and stroke recurrence in patients with intracranial arterial stenosis. In: Circulation. 2007 ; Vol. 115, No. 23. pp. 2969-2975.
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T1 - Relationship between blood pressure and stroke recurrence in patients with intracranial arterial stenosis

AU - Turan, Tanya N.

AU - Cotsonis, George

AU - Lynn, Michael J.

AU - Chaturvedi, Seemant

AU - Chimowitz, Marc

PY - 2007/6

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N2 - BACKGROUND - Many clinicians allow blood pressure to run high in patients with intracranial stenosis to protect against hypoperfusion. We sought to determine whether higher blood pressure decreases the risk of stroke in these patients. METHODS AND RESULTS - Data on 567 patients in the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial were analyzed. Time to ischemic stroke and stroke in the same territory of the stenotic vessel was compared in patients grouped by mean systolic blood pressure (SBP) and mean diastolic blood pressure (DBP) during the study. Additional analyses were based on severity and location of stenosis. Ischemic stroke risk increased with increasing mean SBP and DBP on univariate analysis (P<0.0001, P<0.0001) and after adjustment for risk factors (P=0.0008, P<0.0001). Elevated mean SBP and DBP also resulted in increased risk of stroke in the territory in univariate (P=0.0065, P<0.0001) and adjusted (P=0.0002, P=0.0005) analyses. The increased risk of stroke with increasing SBP was driven largely by patients in the highest SBP group. Patients with moderate (<70%) stenosis had increased risk of stroke (P<0.0001, P=0.003) and stroke in the territory (P=0.0002, P=0.010) with increased SBP and DBP. Patients with severe (<70%) stenosis had increased risk of stroke and stroke in the territory with elevated DBP (P=0.004, P=0.004). CONCLUSIONS - In patients with intracranial stenosis, higher blood pressure is associated with increased (not decreased) risk of ischemic stroke and stroke in the territory of the stenotic vessel. These findings argue strongly against the common clinical practice of maintaining high blood pressure in patients with intracranial stenosis.

AB - BACKGROUND - Many clinicians allow blood pressure to run high in patients with intracranial stenosis to protect against hypoperfusion. We sought to determine whether higher blood pressure decreases the risk of stroke in these patients. METHODS AND RESULTS - Data on 567 patients in the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial were analyzed. Time to ischemic stroke and stroke in the same territory of the stenotic vessel was compared in patients grouped by mean systolic blood pressure (SBP) and mean diastolic blood pressure (DBP) during the study. Additional analyses were based on severity and location of stenosis. Ischemic stroke risk increased with increasing mean SBP and DBP on univariate analysis (P<0.0001, P<0.0001) and after adjustment for risk factors (P=0.0008, P<0.0001). Elevated mean SBP and DBP also resulted in increased risk of stroke in the territory in univariate (P=0.0065, P<0.0001) and adjusted (P=0.0002, P=0.0005) analyses. The increased risk of stroke with increasing SBP was driven largely by patients in the highest SBP group. Patients with moderate (<70%) stenosis had increased risk of stroke (P<0.0001, P=0.003) and stroke in the territory (P=0.0002, P=0.010) with increased SBP and DBP. Patients with severe (<70%) stenosis had increased risk of stroke and stroke in the territory with elevated DBP (P=0.004, P=0.004). CONCLUSIONS - In patients with intracranial stenosis, higher blood pressure is associated with increased (not decreased) risk of ischemic stroke and stroke in the territory of the stenotic vessel. These findings argue strongly against the common clinical practice of maintaining high blood pressure in patients with intracranial stenosis.

KW - Blood pressure

KW - Cerebral infarction

KW - Cerebrovascular circulation

KW - Hypertension

KW - Intracranial arteriosclerosis

KW - Prevention

KW - Stenosis

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