scholarly journals Cerebral hemodynamic effects of early blood pressure lowering after TIA and stroke in patients with carotid stenosis

2022 ◽  
pp. 174749302110686
Author(s):  
Sara Mazzucco ◽  
Linxin Li ◽  
Iain J McGurgan ◽  
Maria Assuncao Tuna ◽  
Nicoletta Brunelli ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Carotid Stenosis ◽  
Peak Systolic Velocity ◽  
Occlusive Disease ◽  
Blood Pressure Lowering ◽  
Carotid Disease ◽  
Acute Setting ◽  
Hypertensive Patients ◽  
Diastolic Velocity ◽  
Pressure Lowering

Background: Effects of early blood pressure (BP) lowering on cerebral perfusion in patients with moderate/severe occlusive carotid disease after transient ischemic attack (TIA) and non-disabling stroke are uncertain. Aims: We aimed to evaluate the changes in transcranial Doppler (TCD) indices in patients undergoing blood pressure lowering soon after TIA/non-disabling stroke. Methods: Consecutive eligible patients (1 November 2011 to 30 October 2018) attending a rapid-access clinic with TIA/non-disabling stroke underwent telemetric home blood pressure monitoring (HBPM) for 1 month and middle cerebral artery velocities measurements ipsilateral to carotid stenosis on TCD ultrasound in the acute setting and at 1 month. Hypertensive patients (HBPM ⩾ 135/85) underwent intensive BP-lowering guided by HBPM unless they had bilateral severe occlusive disease (⩾ 70%). Changes in BP and TCD parameters were compared in patients with extracranial moderate/severe carotid stenosis (between 50% and occlusion) versus those with no or mild (< 50%) stenosis. Results: Of 764 patients with repeated TCD measures, 42 had moderate/severe extracranial carotid stenosis without bilateral severe occlusive disease. HBPM was reduced from baseline to 1 month in hypertensive patients both with versus without moderate/severe carotid stenosis (−12.44/15.99 vs −13.2/12.2 mmHg, respectively, p-difference = 0.82), and changes in TCD velocities (4.69/14.94 vs 2.69/13.86 cm/s, respectively, p-difference = 0.52 for peak systolic velocity and 0.33/7.06 vs 1.75/6.84 cm/s, p-difference = 0.34 for end-diastolic velocity) were also similar, with no evidence of greater hemodynamic compromise in patients with stenosis/occlusion. Conclusion: There was no evidence of worsening of TCD hemodynamic indices in patients with moderate/severe occlusive carotid disease treated with BP-lowering soon after TIA/non-disabling stroke, suggesting that antihypertensive treatment in this group of patients is safe in the acute setting of TIA clinics.

scholarly journals Age-specific cerebral haemodynamic effects of early blood pressure lowering after transient ischaemic attack and non-disabling stroke

2021 ◽  
pp. 239698732110397
Author(s):  
Sara Mazzucco ◽  
Linxin Li ◽  
Iain J McGurgan ◽  
Maria A Tuna ◽  
Nicoletta Brunelli ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Transient Ischaemic Attack ◽  
Blood Pressure Monitoring ◽  
Resistance Index ◽  
Blood Pressure Lowering ◽  
Hypertensive Patients ◽  
Diastolic Velocity ◽  
Pressure Lowering ◽  
Ischaemic Attack ◽  
End Tidal

Introduction There is limited knowledge of the effects of blood pressure (BP) lowering on cerebral haemodynamics after transient ischaemic attack (TIA) and non-disabling stroke, particularly at older ages. We aimed to evaluate changes in transcranial Doppler (TCD) haemodynamic indices in patients undergoing early blood pressure lowering after TIA/non-disabling stroke, irrespective of age. Patients and methods Among consecutive eligible patients attending a rapid-access clinic with suspected TIA/non-disabling stroke and no evidence of extra/intracranial stenosis, hypertensive ones underwent intensive BP-lowering guided by daily home telemetric blood pressure monitoring (HBPM). Clinic-based BP, HBPM, End-tidal CO2 and bilateral middle cerebral artery (MCA) velocity on TCD were compared in the acute setting versus one-month follow-up; changes were stratified by baseline hypertension (clinic-BP≥140/90) and by age (<65, 65–79 and ≥80). Results In 697 patients with repeated TCD measures, mean/SD baseline systolic-BP (145.0/21.3 mmHg) was reduced by an average of 11.3/19.9 mmHg ( p < 0.0001) at one-month (133.7/17.4 mmHg), driven by patients hypertensive at baseline (systolic-BP change = −19.0/19.2 mmHg, p < 0.001; vs −0.5/15.4, p = 0.62 in normotensives). Compared with baseline, a significant change was observed at one-month only in mean/SD MCA end diastolic velocity (EDV) (0.77/7.26 cm/s, p = 0.005) and in resistance index (RI) (−0.005/0.051, p = 0.016), driven by hypertensive patients (mean/SD EDV change: 1.145/6.96 cm/s p = 0.001, RI change −0.007/0.06, p = 0.014). Findings were similar at all ages (EDV change – ptrend=0.357; RI change – ptrend=0.225), including 117 patients aged ≥80. EDV and RI changes were largest in 100 patients with clinic systolic-BP decrease ≥30 mmHg (mean/SD EDV change = 2.49/7.47 cm/s, p = 0.001; RI change −0.024/0.063, p < 0.0001). Conclusion There was no evidence of worsening of TCD haemodynamic indices associated with BP-lowering soon after TIA/non-disabling stroke, irrespective of age and degree of BP reduction. In fact, EDV increase and RI decrease observed after treatment of hypertensive patients suggest a decrease in distal vascular resistance.

Propylbutyldopamine. Mechanism of blood pressure lowering in hypertensive patients.

Hypertension ◽  
1984 ◽  
Vol 6 (2_pt_2) ◽  
Author(s):  
A A Taylor ◽  
W H Fennell ◽  
C O Ruud ◽  
J L Pool ◽  
E B Nelson ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Lowering ◽  
Hypertensive Patients ◽  
Pressure Lowering

scholarly journals Effect of Indomethacin on Blood Pressure Lowering by Captopril and Losartan in Hypertensive Patients

Hypertension ◽  
2000 ◽  
Vol 36 (3) ◽  
pp. 461-465 ◽  
Author(s):  
Paul R. Conlin ◽  
Thomas J. Moore ◽  
Stephen L. Swartz ◽  
Eliav Barr ◽  
Lisa Gazdick ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Lowering ◽  
Hypertensive Patients ◽  
Pressure Lowering

scholarly journals Effect of Different Blood-Pressure-Lowering Regimens on the Blood Pressure Control among Hypertensive Patients Treated in Hospital Conditions

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Anna Paczkowska ◽  
Karolina Hoffmann ◽  
Krzysztof Kus ◽  
Dorota Kopciuch ◽  
Tomasz Zaprutko ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Antihypertensive Drug ◽  
Blood Pressure Control ◽  
Combined Treatment ◽  
Pressure Control ◽  
Antihypertensive Drug Therapy ◽  
Blood Pressure Lowering ◽  
Hypertensive Patients ◽  
Pressure Lowering ◽  
Β Blockers

Background. Scientific references lack sufficient amount of data on analyses of the reasons for hospital admissions or assessment of efficacy of arterial hypertension treatment at hospitals. Objectives. The aim of the study was to evaluate the efficacy of antihypertensive drug therapy on the blood pressure control among hospitalized hypertensive patients. Methodology. A cross-sectional retrospective study consisted of 204 patients aged 18–65 years admitted to the hospital due to hypertension between January 2018 and December 2018. The study was based on analysis of electronic records, obtained from the medical database of the selected healthcare facility. Results. As a result of the treatment applied at the hospital, 65.19% of the patients achieved the desired degree of blood pressure normalization (≤130/80 mmHg). Vast majority of the patients during their stay at the ward would receive three or more hypertensive drugs (63.73%). The most frequently prescribed antihypertensive drug combinations included bitherapies such as diuretics + ACEI and ACEI + β-blockers and tritherapy such as diuretics + β-blockers and calcium channel antagonists and diuretics + ACEI and ARBs. The highest blood-pressure lowering effects were observed among patients receiving combination therapy of a ACEI, a diuretic, and a ARBs. Tritherapy induced a significant mean reduction of inpatients`s SBP compared with bitherapy ( p = 0.0001 ). Conclusion. During their hospital stay, vast majority of patients (65.19%) achieved normal values of blood pressure, mostly owing to combined treatment with several hypertensive drugs. Efficacy of the most frequently used combinations of hypertensive drugs in normalizing arterial pressure varies.

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