Mazzucco Sara, Li Linxin, McGurgan Iain J, Tuna Maria A, Brunelli Nicoletta, Binney Lucy E, Rothwell Peter M
Nuffield Department of Clinical Neurosciences, Wolfson Centre for Prevention of Stroke and Dementia, University of Oxford.
Campus Bio-Medico University of Rome, Rome, Italy.
Eur Stroke J. 2021 Sep;6(3):245-253. doi: 10.1177/23969873211039716. Epub 2021 Sep 4.
There is limited knowledge of the effects of blood pressure (BP) lowering on cerebral haemodynamics after transient ischaemic attack (TIA) and non-disabling stroke, particularly at older ages. We aimed to evaluate changes in transcranial Doppler (TCD) haemodynamic indices in patients undergoing early blood pressure lowering after TIA/non-disabling stroke, irrespective of age.
Among consecutive eligible patients attending a rapid-access clinic with suspected TIA/non-disabling stroke and no evidence of extra/intracranial stenosis, hypertensive ones underwent intensive BP-lowering guided by daily home telemetric blood pressure monitoring (HBPM). Clinic-based BP, HBPM, End-tidal CO and bilateral middle cerebral artery (MCA) velocity on TCD were compared in the acute setting versus one-month follow-up; changes were stratified by baseline hypertension (clinic-BP≥140/90) and by age (<65, 65-79 and ≥80).
In 697 patients with repeated TCD measures, mean/SD baseline systolic-BP (145.0/21.3 mmHg) was reduced by an average of 11.3/19.9 mmHg ( < 0.0001) at one-month (133.7/17.4 mmHg), driven by patients hypertensive at baseline (systolic-BP change = -19.0/19.2 mmHg, < 0.001; vs -0.5/15.4, = 0.62 in normotensives). Compared with baseline, a significant change was observed at one-month only in mean/SD MCA end diastolic velocity (EDV) (0.77/7.26 cm/s, = 0.005) and in resistance index (RI) (-0.005/0.051, = 0.016), driven by hypertensive patients (mean/SD EDV change: 1.145/6.96 cm/s = 0.001, RI change -0.007/0.06, = 0.014). Findings were similar at all ages (EDV change - p=0.357; RI change - p=0.225), including 117 patients aged ≥80. EDV and RI changes were largest in 100 patients with clinic systolic-BP decrease ≥30 mmHg (mean/SD EDV change = 2.49/7.47 cm/s, = 0.001; RI change -0.024/0.063, < 0.0001).
There was no evidence of worsening of TCD haemodynamic indices associated with BP-lowering soon after TIA/non-disabling stroke, irrespective of age and degree of BP reduction. In fact, EDV increase and RI decrease observed after treatment of hypertensive patients suggest a decrease in distal vascular resistance.
关于短暂性脑缺血发作（TIA）和非致残性卒中后血压降低对脑血流动力学的影响，目前了解有限，尤其是在老年人群中。我们旨在评估TIA/非致残性卒中后早期进行血压降低治疗的患者经颅多普勒（TCD）血流动力学指标的变化，年龄不限。
在一家快速就诊诊所连续入选的疑似TIA/非致残性卒中且无颅外/颅内狭窄证据的合格患者中，高血压患者在每日家庭远程血压监测（HBPM）的指导下进行强化血压降低治疗。比较急性发作期与1个月随访时基于诊所的血压、HBPM、呼气末二氧化碳分压（End-tidal CO）以及TCD测量的双侧大脑中动脉（MCA）流速；根据基线高血压情况（诊所血压≥140/90）和年龄（<65岁、65 - 79岁和≥80岁）对变化进行分层。
在697例接受重复TCD测量的患者中，1个月时平均/标准差基线收缩压（145.0/21.3 mmHg）平均降低了11.3/19.9 mmHg（<0.0001），降至133.7/17.4 mmHg，这主要是由基线高血压患者推动的（收缩压变化=-19.0/19.2 mmHg，<0.001；血压正常者变化为-0.5/15.4，P = 0.62）。与基线相比，仅在1个月时观察到平均/标准差MCA舒张末期流速（EDV）（0.77/7.26 cm/s，P = 0.005）和阻力指数（RI）（-0.005/0.051，P = 0.016）有显著变化，这也是由高血压患者推动的（平均/标准差EDV变化：1.145/6.96 cm/s，P = 0.001，RI变化-0.007/0.06，P = 0.014）。所有年龄组的结果相似（EDV变化 - P = 0.357；RI变化 - P = 0.225），包括117例年龄≥80岁的患者。在100例诊所收缩压降低≥30 mmHg的患者中，EDV和RI变化最大（平均/标准差EDV变化 = 2.49/7.47 cm/s，P = 0.001；RI变化-0.024/0.063，<0.0001）。
没有证据表明TIA/非致残性卒中后不久进行血压降低治疗会使TCD血流动力学指标恶化，无论年龄和血压降低程度如何。事实上，高血压患者治疗后观察到的EDV增加和RI降低表明远端血管阻力降低。
