Blood Pressure Is the Determinant for the Increased Risk for Intracranial Arterial Stenosis in Subjects with Elevated Glycated Hemoglobin Levels: The Kangbuk Samsung Health Study

Introduction: Covert brain infarction (CBI) and worsening white matter grade (WMG) on serial MRI are associated with increased risk for ischemic stroke and dementia. Hypothesis: We sought to evaluate the association of various measures of blood pressure and heart rate with these MRI findings. Methods: In the Cardiovascular Health Study, a longitudinal cohort study of cardiovascular disease in older adults, we used relative risk regression to assess the risk of incident CBI and worsening WMG associated with mean, variability, and trend in systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) measured at four or more annual clinic visits between two brain MRIs. We included participants who underwent both brain MRIs and had no change in antihypertensive medication status, no CBI on the initial MRI, and no stroke before the follow-up MRI. Results: Among 897 eligible participants, incident CBI occurred in 15% and worsening WMG in 27%. Mean SBP mean was strongly associated with increased risk for incident CBI (RR per 10 mmHg 1.29; 95% CI, 1.13-1.47), and DBP mean was strongly associated with increased risk for worsening WMG (RR per 10 mmHg 1.43; 95% CI, 1.23-1.67). DBP variability may be associated with incident CBI (RR per 10 mmHg 1.71; 95% CI, 1.10-2.65), The HR measures were not associated with these MRI findings. Conclusions: Elevated mean levels of blood pressure contribute to covert cerebrovascular diseases. Control of mean blood pressure levels, even in older adults, remains a high priority for prevention of vascular brain injury.

Download Full-text

Relationship Between Blood Pressure and Stroke Recurrence in Patients With Intracranial Arterial Stenosis

Circulation ◽

10.1161/circulationaha.106.622464 ◽

2007 ◽

Vol 115 (23) ◽

pp. 2969-2975 ◽

Cited By ~ 103

Author(s):

Tanya N. Turan ◽

George Cotsonis ◽

Michael J. Lynn ◽

Seemant Chaturvedi ◽

Marc Chimowitz

Keyword(s):

Blood Pressure ◽

Arterial Stenosis ◽

Stroke Recurrence ◽

Intracranial Arterial Stenosis

Download Full-text

Association Between Ambulatory Systolic Blood Pressure During the Day and Asymptomatic Intracranial Arterial Stenosis

Hypertension ◽

10.1161/hypertensionaha.113.01838 ◽

2014 ◽

Vol 63 (1) ◽

pp. 61-67 ◽

Cited By ~ 19

Author(s):

Chao-Ting Chen ◽

Yan Li ◽

Jin Zhang ◽

Yan Wang ◽

Hua-Wei Ling ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Arterial Stenosis ◽

Intracranial Arterial Stenosis

Download Full-text

Abstract WP2: Intracranial Stenting with the use of the Wingspan Intracranial Stent for Patients Presenting with Acute Stroke Symptoms and Critical Intracranial Arterial Stenosis.

Stroke ◽

10.1161/str.44.suppl_1.awp2 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Arash Padidar ◽

Pejman Taghavi ◽

Reza Malek ◽

Ursula Tolley ◽

Linda Catalli ◽

...

Keyword(s):

Acute Stroke ◽

Ct Perfusion ◽

Intravenous Thrombolysis ◽

Intracranial Stenosis ◽

Arterial Stenosis ◽

Treatment Modalities ◽

Intracranial Arterial Stenosis ◽

Intracranial Stenting ◽

Intracranial Stent ◽

Increased Risk

Introduction: Patients with pre-existing severe intracranial arterial stenosis are at increased risk of re-current stroke. The treatment modalities for patients presenting with acute stroke symptoms are limited due to risk of re-occlusion after thrombolysis. Following re-canalization of an occluded stenotic vessel, stenting can prevent re-occlusion. Currently the only FDA approved stent specifically indicated for intracranial stenosis is the wingspan stent which is listed as a Humanitarian Use Device (HUD). With the efficacy and safety of intracranial stenting still in question we present a 3 year retrospective review of a community based hospitals outcomes with stenting in an acute stroke setting. Methods: Between 2009-2012 our group treated 47 patients with intracranial stenosis presenting with acute ischemic stroke. These patients had failure of intravenous thrombolysis or had contraindications for its use, had symptomatic intracranial stenosis or tandem lesions, had evidence of salvageable tissue determined by CT perfusion scanning and had an acute infarct not exceeding 1/3 of the affected vascular territory. All patients were treated within 12 hours of the acute event and received the Wingspan intracranial stent after successful thrombolysis. Fifteen patients had posterior circulation stenosis and 32 patients had anterior circulation stenosis. Results: The 30 day post-procedural stroke rate was 12.8%, with a total early mortality rate of 8.4% (Table). The 35 patients with no complications had an average of 4 points improvement in NIHSS post procedure (Figure). Of these patients 15 were discharged home, 10 discharged to acute rehabilitation facilities, and 10 were transferred to nursing homes. Conclusion: Intracranial stenting using the Wingspan device results in significant clinical improvement in patients with acutely symptomatic intracranial stenosis, with acceptable mortality and low rate of symptomatic intracranial hemorrhage.

Download Full-text

Association of self-measured home, ambulatory, and strictly measured office blood pressure and their variability with intracranial arterial stenosis

Journal of Hypertension ◽

10.1097/hjh.0000000000002900 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Takashi Hisamatsu ◽

Takayoshi Ohkubo ◽

Atsushi Hozawa ◽

Akira Fujiyoshi ◽

Sayuki Torii ◽

...

Keyword(s):

Blood Pressure ◽

Office Blood Pressure ◽

Arterial Stenosis ◽

Intracranial Arterial Stenosis

Download Full-text

A1477 The Association of Intracranial Arterial Stenosis with Home Blood Pressure Level and Variability

Journal of Hypertension ◽

10.1097/01.hjh.0000549110.37038.e6 ◽

2018 ◽

Vol 36 ◽

pp. e272

Author(s):

Dongyan Zhang ◽

Hui Chen ◽

Qianhui Guo ◽

Yibang Cheng ◽

Qifang Huang ◽

...

Keyword(s):

Blood Pressure ◽

Blood Pressure Level ◽

Home Blood Pressure ◽

Pressure Level ◽

Arterial Stenosis ◽

Intracranial Arterial Stenosis

Download Full-text

Increased Risk for Intracranial Arterial Stenosis in Subjects With Coronary Artery Calcification

Stroke ◽

10.1161/strokeaha.114.006996 ◽

2015 ◽

Vol 46 (1) ◽

pp. 151-156 ◽

Cited By ~ 7

Author(s):

Hyung-Geun Oh ◽

Pil-Wook Chung ◽

Eun-Jung Rhee

Keyword(s):

Coronary Artery ◽

Coronary Artery Calcification ◽

Arterial Stenosis ◽

Intracranial Arterial Stenosis ◽

Increased Risk

Download Full-text

Abstract P327: Risk Factors for Prehypertension in the Community

Circulation ◽

10.1161/circ.127.suppl_12.ap327 ◽

2013 ◽

Vol 127 (suppl_12) ◽

Author(s):

Lisa Rafalson ◽

Richard P Donahue ◽

Saverio Stranges

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

New York ◽

Weight Gain ◽

Waist Circumference ◽

General Population ◽

Population Based ◽

Health Study ◽

Increased Risk

Background: Prehypertension is an increasingly highly prevalent condition in the general population, and is associated with an increased risk for coronary heart disease and stroke. However, evidence from population-based studies of the risk factors for prehypertension is scant. We sought to examine the predictors of progression from normotension to prehypertension in a community-based population from Western New York. Methods: We conducted a longitudinal analysis, over six years of follow-up, among 569 men and women (51.8 years, 96% White, 70% female) who were free of prehypertension, hypertension, cardiovascular disease and type 2 diabetes at the baseline examination, in the Western New York Health Study (WNYHS). Incident prehypertension at follow-up was defined as systolic blood pressure of 120-139 mmHg and/or diastolic blood pressure of 80-89 mmHg. Results: In bivariate analyses, there were several correlates of incident prehypertension, including age, BMI and waist circumference, impaired fasting glucose (IFG), uric acid, and baseline blood pressure levels. After multivariate adjustment, IFG at baseline odds ratio (OR):1.69, 95%CI:1.06-2.67) and weight gain since age 25 (OR: 1.28, 1.11-1.58 per 10 lb. increase) were the strongest significant predictors of prehypertension at follow-up. Neither waist circumference nor current BMI were predictor variables in models when they were substituted for weight gain. Conclusions: Results from this study suggest early dysregulation of glucose metabolism and weight gain over the lifespan are likely to represent important risk factors for prehypertension in the general population.

Download Full-text