RT Journal Article
SR Electronic
T1 Lower stroke risk with lower blood pressure in hemodynamic cerebral ischemia
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP 1027
OP 1032
DO 10.1212/WNL.0000000000000238
VO 82
IS 12
A1 William J. Powers
A1 William R. Clarke
A1 Robert L. Grubb, Jr
A1 Tom O. Videen
A1 Harold P. Adams, Jr
A1 Colin P. Derdeyn
A1 For the COSS Investigators
YR 2014
UL http://n.neurology.org/content/82/12/1027.abstract
AB Objective: To determine whether strict blood pressure (BP) control is the best medical management for patients with symptomatic carotid artery occlusion and hemodynamic cerebral ischemia.Methods: In this prospective observational cohort study, we analyzed data from 91 participants in the nonsurgical group of the Carotid Occlusion Surgery Study (COSS) who had recent symptomatic internal carotid artery occlusion and hemodynamic cerebral ischemia manifested by ipsilateral increased oxygen extraction fraction. The target BP goal in COSS was ≤130/85 mm Hg. We compared the occurrence of ipsilateral ischemic stroke during follow-up in the 41 participants with mean BP ≤130/85 mm Hg to the remaining 50 with higher BP.Results: Of 16 total ipsilateral ischemic strokes that occurred during follow-up, 3 occurred in the 41 participants with mean follow-up BP of ≤130/85 mm Hg, compared to 13 in the remaining 50 participants with mean follow-up BP >130/85 mm Hg (hazard ratio 3.742, 95% confidence interval 1.065–13.152, log-rank p = 0.027).Conclusion: BPs ≤130/85 mm Hg were associated with lower subsequent stroke risk in these patients.Classification of evidence: This study provides Class III evidence that control of hypertension ≤130/85 mm Hg is associated with a reduced risk of subsequent ipsilateral ischemic stroke in patients with recently symptomatic carotid occlusion and hemodynamic cerebral ischemia (increased oxygen extraction fraction).BP=blood pressure; CI=confidence interval; COSS=Carotid Occlusion Surgery Study; ICA=internal carotid artery; JNC 7=Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure; OEF=oxygen extraction fraction