Higher Stroke Risk with Lower Blood Pressure in Hemodynamic Vertebrobasilar Disease: Analysis from the VERiTAS Study

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• 作者：Sepideh Amin-Hanjani ; MD^* ; ^{hanjani@uic.edu} ; Tanya N. Turan ; MD ; MSCR^&dagger ; ; Xinjian Du ; MD ; MPH^* ; Dilip K. Pandey ; MD ; PhD^&Dagger ; ; Linda Rose-Finnell ; MPA^* ; DeJuran Richardson ; PhD^&Dagger ; ; ^§ ; ; Mitchell S.V. Elkind ; MD ; MS^‖ ; Gregory J. Zipfel ; MD^¶ ; ; David S. Liebeskind ; MD^# ; Frank L. Silver ; MD^** ; Scott E. Kasner ; MD^&dagger ; &dagger ; ; Philip B. Gorelick ; MD ; MPH^&Dagger ; &Dagger ; ; ^§ ; § ; ; Fady T. Charbel ; MD^* ; Colin P. Derdeyn ; MD^¶ ; ; ^‖‖ ; on behalf of the VERiTAS Study Group
• 关键词：Blood flow ; blood pressure ; magnetic resonance imaging ; magnetic resonance angiography ; stroke ; vertebrobasilar disease
• 刊名：Journal of Stroke and Cerebrovascular Diseases
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：26
• 期：2
• 页码：403-410
• 全文大小：355 K
• 卷排序：26

文摘

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.MethodsThe 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.ResultsThe 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.ConclusionsAmong a subgroup of patients with VB disease and low flow, strict BP control (BP <140/90) may increase the risk of subsequent stroke.