Higher Stroke Risk with Lower Blood Pressure in Hemodynamic Vertebrobasilar Disease: Analysis from the VERiTAS Study

Sepideh Amin-Hanjani; Tanya N Turan; Xinjian Du; Dilip K Pandey; Linda Rose-Finnell; DeJuran Richardson; Mitchell S.V Elkind; Gregory J Zipfel; David S Liebeskind; Frank L Silver; Scott E Kasner; Philip B Gorelick; Fady T Charbel; Colin P Derdeyn

doi:10.1016/j.jstrokecerebrovasdis.2016.09.044

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Higher Stroke Risk with Lower Blood Pressure in Hemodynamic Vertebrobasilar Disease: Analysis from the VERiTAS Study

Journal article

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Higher Stroke Risk with Lower Blood Pressure in Hemodynamic Vertebrobasilar Disease: Analysis from the VERiTAS Study

Sepideh Amin-Hanjani, Tanya N Turan, Xinjian Du, Dilip K Pandey, Linda Rose-Finnell, DeJuran Richardson, Mitchell S.V Elkind, Gregory J Zipfel, David S Liebeskind, Frank L Silver, …

Journal of stroke and cerebrovascular diseases, Vol.26(2), pp.403-410

02/2017

DOI: 10.1016/j.jstrokecerebrovasdis.2016.09.044

PMCID: PMC5258769

PMID: 28029608

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Abstract

Despite concerns regarding hypoperfusion in patients with large-artery occlusive disease, strict blood pressure (BP) control has become adopted as a safe strategy for risk reduction of stroke. We examined the relationship between BP control, blood flow, and risk of subsequent stroke in the prospective Vertebrobasilar Flow Evaluation and Risk of Transient Ischemic Attack and Stroke (VERiTAS) study. The VERiTAS study enrolled patients with recent vertebrobasilar (VB) transient ischemic attack or stroke and ≥50% atherosclerotic stenosis or occlusion of vertebral or basilar arteries. Hemodynamic status was designated as low or normal based on quantitative magnetic resonance angiography. Patients underwent standard medical management and follow-up for primary outcome event of VB territory stroke. Mean BP during follow-up (<140/90 versus ≥140/90 mm Hg) and flow status were examined relative to subsequent stroke risk using Cox proportional hazards analysis. The 72 subjects had an average of 3.8 ± 1.2 BP recordings over 20 ± 8 months of follow-up; 39 (54%) had mean BP of<140/90 mm Hg. The BP groups were largely comparable for baseline demographics, risk factors, and stenosis severity. Comparing subgroups stratified by BP and hemodynamic status, we found that patients with both low flow and BP <140/90 mm Hg (n = 10) had the highest risk of subsequent stroke, with hazard ratio of 4.5 (confidence interval 1.3-16.0, P = .02), compared with the other subgroups combined. Among a subgroup of patients with VB disease and low flow, strict BP control (BP <140/90) may increase the risk of subsequent stroke.

blood pressure

magnetic resonance imaging

magnetic resonance angiography

stroke

Blood flow

vertebrobasilar disease

Details

Title: Subtitle: Higher Stroke Risk with Lower Blood Pressure in Hemodynamic Vertebrobasilar Disease: Analysis from the VERiTAS Study
Creators: Sepideh Amin-Hanjani - Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
Tanya N Turan - Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
Xinjian Du - Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
Dilip K Pandey - Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, Illinois
Linda Rose-Finnell - Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
DeJuran Richardson - Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, Illinois
Mitchell S.V Elkind - Departments of Neurology and Epidemiology, Columbia University, New York, New York
Gregory J Zipfel - Departments of Neurosurgery and Neurology, Washington University in St. Louis, St. Louis, Missouri
David S Liebeskind - Neurovascular Imaging and Research Core and Department of Neurology, University of California Los Angeles, Los Angeles, California
Frank L Silver - Department of Medicine, Division of Neurology, University of Toronto, Toronto, Canada
Scott E Kasner - Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania
Philip B Gorelick - Department of Translational Science & Molecular Medicine, Michigan State University College of Human Medicine, East Lansing, Michigan
Fady T Charbel - Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
Colin P Derdeyn - Departments of Neurosurgery and Neurology, Washington University in St. Louis, St. Louis, Missouri
Resource Type: Journal article
Publication Details: Journal of stroke and cerebrovascular diseases, Vol.26(2), pp.403-410
DOI: 10.1016/j.jstrokecerebrovasdis.2016.09.044
PMID: 28029608
PMCID: PMC5258769
NLM abbreviation: J Stroke Cerebrovasc Dis
ISSN: 1052-3057
eISSN: 1532-8511
Publisher: Elsevier Inc
Grant note: R01 NS 059745 / National Institutes of Health/National Institute of Neurological Disorders and Stroke Dr Ralph and Marian Falk Research Trust Foundation
Language: English
Date published: 02/2017
Academic Unit: Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
Record Identifier: 9984013201402771

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