Blood pressure, Severity of Stroke and Preventive Effects of Antihypertensive Therapy in Patients with Asymptomatic Internal Carotid Artery Stenosis - Is blood pressure and antihypertensive therapy associated with outcomes of stroke?

Abstract

Introduction: Even though blood pressure (BP) lowering is important in the primary and secondary prevention of stroke, intensive BP lowering might be deleterious in some patients with asymptomatic carotid artery stenosis (ACAS). The optimal BP target for patients with ACAS is unknown. There are currently no studies showing the relationship between blood pressure and functional outcome of stroke in patients with ACAS. Our aim is to assess the relationship between systolic blood pressure (SBP), stroke and functional outcome of ischemic stroke (IS), in addition to possible protective effects of specific antihypertensive therapy. Materials and methods: Patients with significant stenosis of the internal carotid artery with no prior history of cerebrovascular events were included. Electronic patient journals were individually searched, and clinical and biochemical characteristic were collected. Primary endpoints of cerebrovascular events, IS, transient ischemic attack (TIA) and favorable outcome of stroke were registered. Univariate analysis was performed using χ2 or independent t-test for percentages and continuous variables, respectively. Potential confounders were initially inserted into the logistical regression model and subsequently removed by backward stepwise selection Results: A total of 286 patients were included in this study. SBP was associated with increased risk of cerebrovascular events (OR, 1.013; 95% CI, 1.002 - 1.024; p, 0.017) and IS (OR, 1.018; 95% CI, 1.005 - 1.032; p, 0.009). SBP was positively associated with favorable outcome of IS (OR, 1.032; 95% CI, 1.003 - 1.061; p, 0.028). Patients using calcium channel blockers (CCB) had a significantly lower risk of TIA (p=0.016). Conclusion: This study suggests that SBP is associated with combined cerebrovascular events and IS. In addition, SBP is proportionally associated with good functional outcome after IS. A significantly lower incidence of TIA was observed among patients using CCBs.