Intensive blood pressure lowering for ischemic stroke patients: does it prevent ischemia or bleeding?

• Published in: Hypertension research Vol. 45; no. 5; pp. 769 - 771
• Main Author: Toyoda, Kazunori
• Format: Journal Article
• Language: English
• Published: England Nature Publishing Group 01.05.2022; Springer Nature Singapore
• Subjects: Blood pressure; Blood Pressure - physiology; Brain Ischemia - prevention & control; Comment; Disease prevention; Hemorrhage; Humans; Hypertension; Ischemia; Ischemic Stroke; Stroke; Stroke - prevention & control
• ISSN: 0916-9636; 1348-4214
• DOI: 10.1038/s41440-022-00892-6

In the present post hoc analysis of RESPECT, Kitagawa et al. examined the effect of intensive BP lowering on recurrent stroke subtype risk in patients with a history of ischemic stroke, accounting for 84% of the overall participants in RESPECT [6]. The major finding was that strict BP control aiming at <120/80 mmHg significantly reduced the risk of ICH. Patients assigned to intensive BP lowering did not develop ICH for a mean 3.9-year follow-up, whereas 0.39% of patients assigned to standard BP lowering developed ICH annually. It is less likely that the J-curve phenomenon exists between the follow-up BP levels and the risk of ICH relative to that of ischemic stroke, since possible cerebral hypoperfusion due to systemic hypotension rarely causes bleeding events. Most patients developing ischemic stroke took antithrombotic agents like the present RESPECT cohort, and higher BP levels during antithrombotic medication were associated with incidental ICH, as previous studies on secondary stroke prevention with antithrombotic therapy indicated [3, 4, 7]. A limitation of the analysis of the risk of ICH common to RESPECT and other previous studies is that the incidence of ICH was too low for detailed investigation.