Blood pressures immediately following ischemic strokes are associated with cerebral perfusion and neurologic function

Abstract

The optimal range of blood pressure levels in the early phase of ischemic stroke with hypertension is still controversial. Based on our stroke registry database, we explored the relationship between blood pressure levels and cerebral perfusion in the early phase of ischemic stroke with hypertension and neurofunctional recovery at 3 months after stroke. Total 732 stroke patients with hypertension were finally analyzed. Patients were divided into quintiles according to systolic blood pressure (SBP) and diastolic blood pressure (DBP) to perform multivariable logistic regression to analyze their relation with neurofunctional recovery, respectively. The cerebral perfusion levels displayed a reverse "U" shape curve with the change of blood pressure levels. Sufficient estimated cerebral blood flow (ECBF) in the early phase of ischemic stroke was associated with good neurofunctional recovery at 3 months after stroke. The best neurofunctional recovery was observed in the middle quintiles with SBP at 161 to 177 mm Hg and DBP at 103 to 114 mm Hg, respectively. So maintaining appropriate blood pressure levels in the early phase of ischemic stroke might be beneficial to cerebral perfusion and neurofunctional recovery.

Diastolic Blood Pressure and Intensive Blood Pressure Control on Cognitive Outcomes: Insights From the SPRINT MIND Trial

“…8,36 A longitudinal study observed a reverse U-shaped relationship between DBP immediately following ischemic strokes and cerebral perfusion in hypertensive patients. 8 However, previous randomized controlled trials demonstrated that intensive BP control had no reduction or even improvement on cerebral perfusion, compared with standard BP control. 21,37,38 We further found no evidence that baseline DBP modified the effect of intensive BP control on CBF (interaction P =0.25).…”

“…Nevertheless, in patients with low DBP, aggressive BP reduction raised concerns regarding possible cerebral hypoperfusion, which might potentially result in negative effects on cognitive function. 8,36 A longitudinal study observed a reverse U-shaped relationship between DBP immediately following ischemic strokes and cerebral perfusion in hypertensive patients. 8 However, previous randomized controlled trials demonstrated that intensive BP control had no reduction or even improvement on cerebral perfusion, compared with standard BP control.…”

“…Moreover, it has been reported that low DBP harms cerebral perfusion, [8][9][10] which is particularly true for aging patients with chronic hypertension in whom cerebral autoregulation can be impaired by vessel endothelium injury and arterial stiffness. [11][12][13] Autoregulatory range of cerebral blood flow (CBF) is at a higher level in those with chronic hypertension, raising the concern that cerebral perfusion can be inadequate when DBP is low, especially in patients with hypertension.…”

Burden of cerebral small vessel disease and changes of diastolic blood pressure affect clinical outcome after acute ischemic stroke

“…There was even a decrease in CBF within normal appearing white matter surrounding the WMH 51 . On the other hand, levels of cerebral perfusion especially in the early phase of AIS display a reverse U-shaped curve depending on SBP and DBP levels and -in turn -impact functional outcome at 3 months after stroke 52 . The most favorable functional outcome was associated with a SBP between 161 to 177 mmHg and DBP ranging from 103 to 114 mmHg 52 .…”

“…On the other hand, levels of cerebral perfusion especially in the early phase of AIS display a reverse U-shaped curve depending on SBP and DBP levels and -in turn -impact functional outcome at 3 months after stroke 52 . The most favorable functional outcome was associated with a SBP between 161 to 177 mmHg and DBP ranging from 103 to 114 mmHg 52 . Interestingly, Park and Ovbiagele found also an independent association between DBP and vascular outcomes 2 years after non-cardioembolic stroke, showing that DBP < 70 mmHg as well as DBP > 90 mmHg was linked to an increased risk of vascular events 53 .…”