William J Powers1, William R Clarke, Robert L Grubb, Tom O Videen, Harold P Adams, Colin P Derdeyn. 1. From the Department of Neurology (W.J.P.), University of North Carolina School of Medicine, Chapel Hill; Clinical Trials Statistics and Data Management Center (W.R.C.), University of Iowa College of Public Health, Iowa City; Departments of Neurological Surgery (R.L.G., C.P.D.), Radiology (R.L.G., T.O.V., C.P.D.), and Neurology (T.O.V., C.P.D.), Washington University School of Medicine, St. Louis, MO; and the Department of Neurology (H.P.A.), University of Iowa Carver School of Medicine, Iowa City.
Abstract
OBJECTIVE: To determine whether strict blood pressure (BP) control is the best medical management for patients with symptomatic carotid artery occlusion and hemodynamic cerebral ischemia. METHODS: In this prospective observational cohort study, we analyzed data from 91 participants in the nonsurgical group of the Carotid Occlusion Surgery Study (COSS) who had recent symptomatic internal carotid artery occlusion and hemodynamic cerebral ischemia manifested by ipsilateral increased oxygen extraction fraction. The target BP goal in COSS was ≤130/85 mm Hg. We compared the occurrence of ipsilateral ischemic stroke during follow-up in the 41 participants with mean BP ≤130/85 mm Hg to the remaining 50 with higher BP. RESULTS: Of 16 total ipsilateral ischemic strokes that occurred during follow-up, 3 occurred in the 41 participants with mean follow-up BP of ≤130/85 mm Hg, compared to 13 in the remaining 50 participants with mean follow-up BP >130/85 mm Hg (hazard ratio 3.742, 95% confidence interval 1.065-13.152, log-rank p = 0.027). CONCLUSION: BPs ≤130/85 mm Hg were associated with lower subsequent stroke risk in these patients. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that control of hypertension ≤130/85 mm Hg is associated with a reduced risk of subsequent ipsilateral ischemic stroke in patients with recently symptomatic carotid occlusion and hemodynamic cerebral ischemia (increased oxygen extraction fraction).
RCT Entities:
OBJECTIVE: To determine whether strict blood pressure (BP) control is the best medical management for patients with symptomatic carotid artery occlusion and hemodynamic cerebral ischemia. METHODS: In this prospective observational cohort study, we analyzed data from 91 participants in the nonsurgical group of the Carotid Occlusion Surgery Study (COSS) who had recent symptomatic internal carotid artery occlusion and hemodynamic cerebral ischemia manifested by ipsilateral increased oxygen extraction fraction. The target BP goal in COSS was ≤130/85 mm Hg. We compared the occurrence of ipsilateral ischemic stroke during follow-up in the 41 participants with mean BP ≤130/85 mm Hg to the remaining 50 with higher BP. RESULTS: Of 16 total ipsilateral ischemic strokes that occurred during follow-up, 3 occurred in the 41 participants with mean follow-up BP of ≤130/85 mm Hg, compared to 13 in the remaining 50 participants with mean follow-up BP >130/85 mm Hg (hazard ratio 3.742, 95% confidence interval 1.065-13.152, log-rank p = 0.027). CONCLUSION: BPs ≤130/85 mm Hg were associated with lower subsequent stroke risk in these patients. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that control of hypertension ≤130/85 mm Hg is associated with a reduced risk of subsequent ipsilateral ischemic stroke in patients with recently symptomatic carotid occlusion and hemodynamic cerebral ischemia (increased oxygen extraction fraction).
Authors: Hisatomi Arima; John Chalmers; Mark Woodward; Craig Anderson; Anthony Rodgers; Stephen Davis; Stephen Macmahon; Bruce Neal Journal: J Hypertens Date: 2006-06 Impact factor: 4.844
Authors: Robert L Grubb; William J Powers; William R Clarke; Tom O Videen; Harold P Adams; Colin P Derdeyn Journal: J Neurosurg Date: 2012-10-26 Impact factor: 5.115
Authors: Tanya N Turan; George Cotsonis; Michael J Lynn; Seemant Chaturvedi; Marc Chimowitz Journal: Circulation Date: 2007-05-21 Impact factor: 29.690
Authors: R L Grubb; C P Derdeyn; S M Fritsch; D A Carpenter; K D Yundt; T O Videen; E L Spitznagel; W J Powers Journal: JAMA Date: 1998 Sep 23-30 Impact factor: 56.272
Authors: Diogo C Haussen; David Z Rose; Doniel Drazin; Scott D Newsome; Hannah Gardener; Randall C Edgell; Alan Boulos; Gary Bernardini; Tatjana Rundek; Dileep R Yavagal Journal: Interv Neurol Date: 2015-07
Authors: 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 Journal: J Stroke Cerebrovasc Dis Date: 2016-10-28 Impact factor: 2.136
Authors: Tanya N Turan; Jenifer H Voeks; Marc I Chimowitz; Ana Roldan; Todd LeMatty; William Haley; Maria Lopes-Virella; Seemant Chaturvedi; Michael Jones; Donald Heck; George Howard; Brajesh K Lal; James F Meschia; Thomas G Brott Journal: Stroke Date: 2020-09-21 Impact factor: 7.914
Authors: Tanya N Turan; Azhar Nizam; Michael J Lynn; Brent M Egan; Ngoc-Anh Le; Maria F Lopes-Virella; Kathie L Hermayer; Jamie Harrell; Colin P Derdeyn; David Fiorella; L Scott Janis; Bethany Lane; Jean Montgomery; Marc I Chimowitz Journal: Neurology Date: 2016-12-21 Impact factor: 9.910
Authors: William Haley; Fayaz Shawl; W Charles Sternbergh; Tanya N Turan; Kevin Barrett; Jenifer Voeks; Thomas Brott; James F Meschia Journal: J Stroke Cerebrovasc Dis Date: 2021-06-18 Impact factor: 2.677
Authors: Jose Gutierrez; Farid Khasiyev; Minghua Liu; Janet T DeRosa; Sarah E Tom; Tatjana Rundek; Ken Cheung; Clinton B Wright; Ralph L Sacco; Mitchell S V Elkind Journal: J Am Coll Cardiol Date: 2021-08-10 Impact factor: 27.203