This site is intended for UK healthcare professionals
Medscape UK Univadis Logo
Medscape UK Univadis Logo
News

Recent premorbid BP control tied to acute lacunar events at younger ages

Recent premorbid BP is strongly temporarily related to acute lacunar events at younger ages, a study published in the journal Neurology reports. The findings reveal that at younger ages, BP plays a direct role in the aetiology of small vessel and highlights the need for timely control of BP after diagnosis. The researchers also suggest that diastolic BP (DBP) should be considered to prevent small vessel disease, particularly in young and middle-aged individuals

In this population-based study of TIA/ischaemic stroke (Oxford Vascular Study), researchers evaluated 15-year premorbid BP measurement from primary care records of 2085 patients (stroke, n=1250; TIA, n=835) with lacunar vs nonlacunar events stratified by age (Trial of Org 10172 in Acute Stroke Treatment [TOAST]) stratified by age (<65 and ≥65 years).

Of 2085 patients, 309 had lacunar events and 1776 had nonlacunar events. In 493 patients aged <65 years, there was no significant difference in the prevalence of hypertension (48.4% vs 41.2%; P=.20) and premorbid use of antihypertensive agents (33.7% vs 34.4%; P=.89) between lacunar and nonlacunar events (48.4% vs 41.2%; P=.20). Mean 15-year premorbid BP measurement (total of 44,496 BP readings) was higher in patients with lacunar events vs those with nonlacunar events (15-year records: systolic BP (SBP), 138.5/17.7 vs 133.3/15.0 mmHg; P=.004; DBP, 84.1/9.6 vs 80.9/8.4 mmHg; P=.001) primarily because of higher mean BP ≤5 years before the event (SBP, 142.6/18.8 vs 134.6/16.6 mmHg; P=.0001; DBP, 85.2/9.7 vs 80.6/9.0 mmHg; P<.0001).

Maximum BP during 5 years before the event was also higher in patients with lacunar events vs those with nonlacunar events (SBP, 173.7/26.6 vs 158.6/23.2 mmHg; P=.0001; DBP, 102.3/12.9 vs 94.2/11.2 mmHg; P<.0001). Patients with lacunar events were more likely to have persistently elevated BP at different target levels (≥50% SBP >160 mmHg; OR, 4.95; P=.0002). No similar differences in BP were observed in patients ≥65 years of age.

The authors pointed out that more research is required to understand the complex association of BP and lacunar events at older ages. They further added, “Our findings highlight the difficulty of excluding confounding by hypertension in the absence of detailed records of prior BP control.”


References


YOU MAY ALSO LIKE