Lower stroke risk with lower blood pressure in hemodynamic cerebral ischemia.

Journal Article (Journal Article;Multicenter Study)

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).

Full Text

Duke Authors

Cited Authors

  • Powers, WJ; Clarke, WR; Grubb, RL; Videen, TO; Adams, HP; Derdeyn, CP; COSS Investigators,

Published Date

  • March 25, 2014

Published In

Volume / Issue

  • 82 / 12

Start / End Page

  • 1027 - 1032

PubMed ID

  • 24532276

Pubmed Central ID

  • PMC3962994

Electronic International Standard Serial Number (EISSN)

  • 1526-632X

Digital Object Identifier (DOI)

  • 10.1212/WNL.0000000000000238


  • eng

Conference Location

  • United States