Focal cerebral ischaemia and infarction due to antihypertensive therapy

Hankey, Graeme J.; Gubbay, S S

doi:10.5694/j.1326-5377.1987.tb120332.x

Cited by 43 publications

(6 citation statements)

References 11 publications

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“…17 18 Concerns about decreasing cerebral perfusion and thereby worsening cognition with lowering of systemic BP in older adults have limited aggressive HTN management in clinical practice. [19][20][21][22] However, studies indicate protective adaptation of the Strengths and limitations of this study ► This is a meta-analysis of nine published randomised controlled trials with almost 35 000 participants included in this analysis. ► We converted ORs to standardised mean difference, which enabled us to include studies reporting incident dementia, mild cognitive impairment or cognitive decline on continuous measures.…”

Section: Introductionmentioning

confidence: 99%

Treatment of hypertension reduces cognitive decline in older adults: a systematic review and meta-analysis

et al. 2020

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ObjectivesTo systematically analyse the effect of pharmacological treatment of hypertension (HTN) on cognitive decline in older adults.MethodsRandomised, placebo-controlled trials with a prespecified quantitative outcome of cognition and a pharmacological intervention for at least 12 months to treat HTN in older adults (>60 years). Our primary outcome was change in cognition with pharmacological treatment of HTN. Standardised mean difference (SMD) was used to analyse different outcomes reported in the selected studies. We searched PubMed CENTRAL and the Cochrane Library from inception to 6 July 2020. Two independent reviewers assessed trial quality and extracted data. Internal and external validity of the studies was assessed.ResultsNine randomised controlled trials with 34 994 participants were included in the final analysis. The net SMD for change in cognition was −0.049 (CI: −0.078 to −0.019) indicating that treatment of HTN decreased cognitive decline. Heterogeneity was low with an I² of 6%.DiscussionCurrent evidence does not indicate worsening of cognition with treatment of HTN. Treatment of HTN in older adults may reduce cognitive decline. These results have important implications in clinical management of patients at risk for dementia.PROSPERO registration numberCRD42020139750.

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Section: Introductionmentioning

confidence: 99%

Treatment of hypertension reduces cognitive decline in older adults: a systematic review and meta-analysis

et al. 2020

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“…The reported series now amount to a collective total of over 50 patients. Many of them are elderly with diabetes and significant carotid stenoses; 7,18 others have systolic hypertension and develop postural hypotension following the introduction of drug therapy 19,20 . The phenomenon of limb shaking secondary to transient focal cerebral ischaemia is also recognized 21 .…”

Section: Patient Characteristics Tilt‐test Results and Follow Upmentioning

confidence: 99%

“…Many of them are elderly with diabetes and significant carotid stenoses; 7,18 others have systolic hypertension and develop postural hypotension following the introduction of drug therapy. 19,20 The phenomenon of limb shaking secondary to transient focal cerebral ischaemia is also recognized. 21 We have shown that tilt testing may be useful as a novel method for confirming the diagnosis of hypotensive TIA in elderly patients.…”

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confidence: 99%

Tilt‐test diagnosis of hypotensive transient ischaemic attacks

Jardine

Hurrell

Fink

2007

Internal Medicine Journal

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Eight elderly patients with postural hypotension who presented with transient ischaemic attacks are reported. Six patients underwent head-up tilt testing with continuous blood pressure monitoring. During tilt, postural hypotension was found in five patients and in three patients transient ischaemic attacks were reproduced. Postural hypotension is probably a rare cause of transient ischaemic attacks, but may be underrecognized.

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“…In hypertensive patients with cerebral vascular disease, "steal" may occur with the use of arteriolar dilators, such as prazosin and hydralazine, and lead to cerebral ischemia and "watershed infarcts" in the brain [50][51][52][53], in a similar fashion to the generation of vascular "steal" in the heart [13] (Fig. 2).…”

Section: Hemodynamic Effects In Diseasementioning

confidence: 99%

Pulse wave mechanics revisited: Relevance to therapy of cardiovascular disease with calcium antagonists

O’Rourke

1992

Heart Vessels

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Focal cerebral ischaemia and infarction due to antihypertensive therapy

Cited by 43 publications

References 11 publications

Treatment of hypertension reduces cognitive decline in older adults: a systematic review and meta-analysis

Treatment of hypertension reduces cognitive decline in older adults: a systematic review and meta-analysis

Tilt‐test diagnosis of hypotensive transient ischaemic attacks

Pulse wave mechanics revisited: Relevance to therapy of cardiovascular disease with calcium antagonists

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