Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
Campus Bio-Medico University of Rome, Rome, Italy.
Int J Stroke. 2022 Dec;17(10):1114-1120. doi: 10.1177/17474930211068655. Epub 2022 Jan 7.
Effects of early blood pressure (BP) lowering on cerebral perfusion in patients with moderate/severe occlusive carotid disease after transient ischemic attack (TIA) and non-disabling stroke are uncertain.
We aimed to evaluate the changes in transcranial Doppler (TCD) indices in patients undergoing blood pressure lowering soon after TIA/non-disabling stroke.
Consecutive eligible patients (1 November 2011 to 30 October 2018) attending a rapid-access clinic with TIA/non-disabling stroke underwent telemetric home blood pressure monitoring (HBPM) for 1 month and middle cerebral artery velocities measurements ipsilateral to carotid stenosis on TCD ultrasound in the acute setting and at 1 month. Hypertensive patients (HBPM ⩾ 135/85) underwent intensive BP-lowering guided by HBPM unless they had bilateral severe occlusive disease (⩾ 70%). Changes in BP and TCD parameters were compared in patients with extracranial moderate/severe carotid stenosis (between 50% and occlusion) versus those with no or mild (< 50%) stenosis.
Of 764 patients with repeated TCD measures, 42 had moderate/severe extracranial carotid stenosis without bilateral severe occlusive disease. HBPM was reduced from baseline to 1 month in hypertensive patients both with versus without moderate/severe carotid stenosis (-12.44/15.99 vs -13.2/12.2 mmHg, respectively, p-difference = 0.82), and changes in TCD velocities (4.69/14.94 vs 2.69/13.86 cm/s, respectively, p-difference = 0.52 for peak systolic velocity and 0.33/7.06 vs 1.75/6.84 cm/s, p-difference = 0.34 for end-diastolic velocity) were also similar, with no evidence of greater hemodynamic compromise in patients with stenosis/occlusion.
There was no evidence of worsening of TCD hemodynamic indices in patients with moderate/severe occlusive carotid disease treated with BP-lowering soon after TIA/non-disabling stroke, suggesting that antihypertensive treatment in this group of patients is safe in the acute setting of TIA clinics.
短暂性脑缺血发作（TIA）和非致残性卒后，中重度颈动脉闭塞患者早期降压对脑灌注的影响尚不确定。
我们旨在评估 TIA/非致残性卒后行降压治疗患者 TCD 指数的变化。
连续入选 2011 年 11 月 1 日至 2018 年 10 月 30 日于快速就诊诊所就诊的 TIA/非致残性卒患者，接受 1 个月的家庭血压监测（HBPM），并在急性发病时和 1 个月时进行经颅多普勒超声（TCD）测量同侧大脑中动脉速度。高血压患者（HBPM ⩾ 135/85mmHg）接受 HBPM 指导的强化降压治疗，除非他们有双侧严重闭塞性疾病（⩾ 70%）。比较有和无颅外中重度颈动脉狭窄（50%至闭塞）患者的血压和 TCD 参数变化。
在 764 例重复 TCD 测量患者中，42 例有颅外中重度颈动脉狭窄而无双侧严重闭塞性疾病。高血压患者的 HBPM 从基线至 1 个月均有下降，有和无颅外中重度颈动脉狭窄患者分别为（-12.44/15.99mmHg 比-13.2/12.2mmHg，p 差值=0.82），TCD 流速的变化（收缩期峰值流速分别为 4.69/14.94cm/s 比 2.69/13.86cm/s，p 差值=0.52；舒张末期流速分别为 0.33/7.06cm/s 比 1.75/6.84cm/s，p 差值=0.34）也相似，无狭窄/闭塞患者的血液动力学更严重受损的证据。
TIA/非致残性卒后行降压治疗的中重度颈动脉闭塞患者的 TCD 血液动力学指数无恶化证据，提示在 TIA 诊所的急性治疗中，此类患者的降压治疗是安全的。
