Transient ischemic attacks associated with hypotension in hypertensive patients with carotid artery stenosis.

In a group of 132 patients with transient ischemic attacks ((TIAs) 7 patients (4 men, 3 women, ages 64 to 81) had TIAs preceded by hypotension. The average fall of mean blood pressure during an attack was 26.4 +/- 5.5 mm Hg (SD). Only one of these patients had a TIA which was not preceded by hypotension. This episode occurred during a paroxysm of coughing. All 7 of these patients had hypertension, and cerebral arteriography performed in 4 of the 7 revealed hemodynamically significant carotid artery stenosis. Each of the 4 patients developed hypotension and a TIA after the procedure. Twenty of the other patients had hypotensive episodes but did not develop focal neurological deficits. None of these patients had carotid artery stenosis. This study suggests that hypertensive patients with carotid artery stenosis may be at risk to develop focal cerebral ischemia during acute hypotensive episodes.