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Blood pressure reduction in hypertensive acute ischemic stroke patients does not affect cerebral blood flow.
J Cereb Blood Flow Metab. 2019 09; 39(9):1878-1887.JC

Abstract

The effect of blood pressure (BP) reduction on cerebral blood flow (CBF) in acute ischemic stroke is unknown. We measured regional CBF with perfusion-weighted MRI before and after BP treatment in a three-armed non-randomized prospective controlled trial. Treatment arm assignment was based on acute mean arterial pressure (MAP). Patients with (MAP) >120 mmHg (n = 14) were treated with intravenous labetalol and sublingual (SL) nitroglycerin (labetalol group). Those with MAP 100-120 mmHg (n = 17) were treated with SL nitroglycerin (0.3 mg) ('NTG Group') and those with baseline MAP<100 mmHg (n = 18) were not treated with antihypertensive drugs (untreated group). Forty-nine patients (18 female, mean age 65.3 ± 12.9 years) were serially imaged. Labetalol reduced MAP by 12.5 (5.7-17.7) mmHg, p = 0.0002. MAP remained stable in the NTG (6.0 (0.4-16, p = 0.3) mmHg and untreated groups (-0.3 (-2.3-7.0, p = 0.2) mmHg. The volume of total hypoperfused tissue (CBF<18 ml/100 g/min) did not increase after labetalol (-1.1 ((-6.5)-(-0.2)) ml, p = 0.1), NTG (0 ((-1.5)-4.5) ml, p = 0.72), or no treatment 0.25 ((-10.1)-4.5) ml, p = 0.87). Antihypertensive therapy, based on presenting BP, in acute stroke patients was not associated with an increased volume of total hypoperfused tissue.

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Authors+Show Affiliations

1 Division of Neurology, University of Alberta, Edmonton, Canada.

2 Department of Neurology, University of Miami, Miami, FL, USA.

1 Division of Neurology, University of Alberta, Edmonton, Canada.

1 Division of Neurology, University of Alberta, Edmonton, Canada.

3 Department of Medicine, Division of General Internal Medicine, University of Alberta, Edmonton, Canada.

1 Division of Neurology, University of Alberta, Edmonton, Canada.

1 Division of Neurology, University of Alberta, Edmonton, Canada.

4 Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada.

5 Department of Biomedical Engineering, University of Alberta, Edmonton, Canada.

1 Division of Neurology, University of Alberta, Edmonton, Canada.

MeSH

AgedAntihypertensive AgentsBlood PressureBrain IschemiaCerebrovascular CirculationFemaleHumansHypertensionLabetalolMaleMiddle AgedNitroglycerinStrokeVasodilator Agents

Pub Type(s)

Journal Article

Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29737226

Citation

Kate, Mahesh, et al. "Blood Pressure Reduction in Hypertensive Acute Ischemic Stroke Patients Does Not Affect Cerebral Blood Flow." Journal of Cerebral Blood Flow and Metabolism : Official Journal of the International Society of Cerebral Blood Flow and Metabolism, vol. 39, no. 9, 2019, pp. 1878-1887.

Kate M, Asdaghi N, Gioia LC, et al. Blood pressure reduction in hypertensive acute ischemic stroke patients does not affect cerebral blood flow. J Cereb Blood Flow Metab. 2019;39(9):1878-1887.

Kate, M., Asdaghi, N., Gioia, L. C., Buck, B., Majumdar, S. R., Jeerakathil, T., Shuaib, A., Emery, D., Beaulieu, C., & Butcher, K. (2019). Blood pressure reduction in hypertensive acute ischemic stroke patients does not affect cerebral blood flow. Journal of Cerebral Blood Flow and Metabolism : Official Journal of the International Society of Cerebral Blood Flow and Metabolism, 39(9), 1878-1887. https://doi.org/10.1177/0271678X18774708

Kate M, et al. Blood Pressure Reduction in Hypertensive Acute Ischemic Stroke Patients Does Not Affect Cerebral Blood Flow. J Cereb Blood Flow Metab. 2019;39(9):1878-1887. PubMed PMID: 29737226.

* Article titles in AMA citation format should be in sentence-case

TY - JOUR T1 - Blood pressure reduction in hypertensive acute ischemic stroke patients does not affect cerebral blood flow. AU - Kate,Mahesh, AU - Asdaghi,Negar, AU - Gioia,Laura C, AU - Buck,Brian, AU - Majumdar,Sumit R, AU - Jeerakathil,Thomas, AU - Shuaib,Ashfaq, AU - Emery,Derek, AU - Beaulieu,Christian, AU - Butcher,Kenneth, Y1 - 2018/05/08/ PY - 2018/5/9/pubmed PY - 2020/5/27/medline PY - 2018/5/9/entrez KW - Blood pressure KW - acute ischemic stroke KW - cerebral blood flow KW - labetalol KW - nitroglycerin SP - 1878 EP - 1887 JF - Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism JO - J Cereb Blood Flow Metab VL - 39 IS - 9 N2 - The effect of blood pressure (BP) reduction on cerebral blood flow (CBF) in acute ischemic stroke is unknown. We measured regional CBF with perfusion-weighted MRI before and after BP treatment in a three-armed non-randomized prospective controlled trial. Treatment arm assignment was based on acute mean arterial pressure (MAP). Patients with (MAP) >120 mmHg (n = 14) were treated with intravenous labetalol and sublingual (SL) nitroglycerin (labetalol group). Those with MAP 100-120 mmHg (n = 17) were treated with SL nitroglycerin (0.3 mg) ('NTG Group') and those with baseline MAP<100 mmHg (n = 18) were not treated with antihypertensive drugs (untreated group). Forty-nine patients (18 female, mean age 65.3 ± 12.9 years) were serially imaged. Labetalol reduced MAP by 12.5 (5.7-17.7) mmHg, p = 0.0002. MAP remained stable in the NTG (6.0 (0.4-16, p = 0.3) mmHg and untreated groups (-0.3 (-2.3-7.0, p = 0.2) mmHg. The volume of total hypoperfused tissue (CBF<18 ml/100 g/min) did not increase after labetalol (-1.1 ((-6.5)-(-0.2)) ml, p = 0.1), NTG (0 ((-1.5)-4.5) ml, p = 0.72), or no treatment 0.25 ((-10.1)-4.5) ml, p = 0.87). Antihypertensive therapy, based on presenting BP, in acute stroke patients was not associated with an increased volume of total hypoperfused tissue. SN - 1559-7016 UR - https://www.unboundmedicine.com/medline/citation/29737226/Blood_pressure_reduction_in_hypertensive_acute_ischemic_stroke_patients_does_not_affect_cerebral_blood_flow_ DB - PRIME DP - Unbound Medicine ER -