Antihypertensive therapy in atherothrombotic stroke survivors with or without reduced acetazolamide reactivity. A long-term prospective study.
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It remains controversial how to manage hypertension in stroke survivors. Some studies have indicated that antihypertensive therapy can effectively reduce stroke recurrence. Based on other observations, however, even a mild reduction of systemic blood pressure brought about TIA or ischemic stroke in patients with a reduced vasodilatory capacity in the brain. Employing single photon emission computed tomography (SPECT) with acetazolamide (ACZ) challenge, we examined 107 consecutive patients with severe stenosis (≥ 75% in diameter) or occlusion of the internal carotid artery or middle cerebral artery, who demonstrated no or minimal hypodensity on CT. The patients were divided into two groups : normal (negative ACZ, n=50) or reduced ACZ reactivity (positive ACZ, n=57), according to the criteria reported earlier. They were examined prospectively at regular intervals for 2.7 years. Stroke recurred in 15 patients : 6 with normal and 9 with reduced ACZ reactivities. Multivariate analysis with a Cox's proportional hazards model demonstrated that antihypertensive therapy significantly reduced stroke recurrence (coefficient=0.21, hazard ratio=0.071, 95% CI : 0.007 to 0.689, p=0.02), However, no other variables, including the ACZ reactivity, affected the stroke recurrence rate. Three of 4 patients with probable hemodynamic recurrence had a reduced ACZ reactivity at entry. Stroke recurred ipsilaterally to the arterial stenosis/occlusion in patients with positive ACZ who were given antihypertensive medication. The present findings indicate that antihypertensive therapy can effectively stroke reduce recurrence, particularly in patients with a normal ACZ reactivity. However, antihypertensive medication may have a danger of inducing "hemodynamic" stroke recurrence in some patients with a reduced ACZ reactivity.
- 一般社団法人 日本脳卒中学会の論文
一般社団法人 日本脳卒中学会 | 論文
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