Blood Pressure Control for Patients with Middle Cerebral Artery Severe Stenosis or Occlusion.

Background: Chronic hypertension is an independent risk factor for ischemic stroke and worsens prognosis. However, the level of blood pressure control in hypertensive patients with severe intracranial stenosis is controversial.

Purpose: To investigate the effect of different levels of blood pressure on cerebral perfusion in patients with middle cerebral artery severe stenosis or occlusion.

Materials and methods: A total of 105 patients with isolated steno-occlusive middle cerebral artery (MCA) diagnosed by digital subtraction angiography (DSA) were enrolled, and PWI was compulsory. Relative risk factors were obtained by intergroup analysis in both hypertensive and non-hypertensive groups, and multivariable logistic regression was performed to determine whether hypertension was independently associated with PWI values. Next, the effects of different levels of blood pressure levels on cerebral perfusion as a whole and subgroup were further compared.

Results: The hypertension (HT) group (Am 1.04±0.05, Lm 1.07±0.06, Pm 1.07±0.05) demonstrated lower cerebral perfusion pressure at a larger rMTT (p=0.0001, 0.004, 0.006) than the nonhypertension (NHT) group (Am 1.01±0.21, Lm 1.04±0.04, Pm 1.04±0.04). After adjustment for age, diabetes, and fibrinogen (FIB), HT was independently associated with the rMTT of Am, Lm, and Pm (P=0.015, 0.001, 0.022). Significant differences were observed with HT+SBP<140 (p=0.035, 0.048, 0.049) and HT+DBP<80 (p=0.034, 0.045, 0.055) in rMTT compared with NHT.

Conclusion: Chronic hypertension might damage cerebral perfusion. Strictly control of blood pressure (<140/80mmHg) in hypertensive patients with intracranial artery stenosis will further reduce ipsilateral cerebral perfusion.