This Article Free upon publication Full Text Full Text (PDF) CME: Take the course for this article: Circulation: June 12, 2007, Volume 115, Number 23 All Versions of this Article: 115/23/2969    most recent CIRCULATIONAHA.106.622464v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Turan, T. N. Search for Related Content PubMed PubMed Citation Articles by Turan, T. N. Pubmed/NCBI databases Medline Plus Health Information Stroke Related Collections Other Stroke Treatment - Medical Cerebrovascular disease/stroke Secondary prevention Acute Cerebral Infarction

(Circulation. 2007;115:2969-2975.)
© 2007 American Heart Association, Inc.

Stroke

Relationship Between Blood Pressure and Stroke Recurrence in Patients With Intracranial Arterial Stenosis

Tanya N. Turan, MD; George Cotsonis, MA; Michael J. Lynn, MS; Seemant Chaturvedi, MD; Marc Chimowitz, MB, ChB, for the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) Trial Investigators

From Emory University, Atlanta, Ga (T.N.T., G.C., M.J.L., M.C.), and Wayne State University, Detroit, Mich (S.C.).

Correspondence to Tanya N. Turan, MD, Department of Neurology, 6000 Woodruff Memorial Bldg, PO Drawer V, Atlanta, GA 30322. E-mail tturan{at}emory.edu

Received February 22, 2006; accepted April 6, 2007.

Background— Many clinicians allow blood pressure to run high in patients with intracranial stenosis to protect against hypoperfusion. We sought to determine whether higher blood pressure decreases the risk of stroke in these patients.

Methods and Results— Data on 567 patients in the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial were analyzed. Time to ischemic stroke and stroke in the same territory of the stenotic vessel was compared in patients grouped by mean systolic blood pressure (SBP) and mean diastolic blood pressure (DBP) during the study. Additional analyses were based on severity and location of stenosis. Ischemic stroke risk increased with increasing mean SBP and DBP on univariate analysis (P<0.0001, P<0.0001) and after adjustment for risk factors (P=0.0008, P<0.0001). Elevated mean SBP and DBP also resulted in increased risk of stroke in the territory in univariate (P=0.0065, P<0.0001) and adjusted (P=0.0002, P=0.0005) analyses. The increased risk of stroke with increasing SBP was driven largely by patients in the highest SBP group. Patients with moderate (<70%) stenosis had increased risk of stroke (P<0.0001, P=0.003) and stroke in the territory (P=0.0002, P=0.010) with increased SBP and DBP. Patients with severe (70%) stenosis had increased risk of stroke and stroke in the territory with elevated DBP (P=0.004, P=0.004).

Conclusions— In patients with intracranial stenosis, higher blood pressure is associated with increased (not decreased) risk of ischemic stroke and stroke in the territory of the stenotic vessel. These findings argue strongly against the common clinical practice of maintaining high blood pressure in patients with intracranial stenosis.

---

 

CLINICAL PERSPECTIVE

This article has been cited by other articles:

				J. F. E. Mann What's new in hypertension 2007? Nephrol. Dial. Transplant., February 1, 2008; 23(2): 466 - 470. [Full Text] [PDF]