Stroke: what are the optimal BP levels to prevent cognitive decline?

Takeaway

• Study shows maintaining systolic BP in the range of 143-158 mmHg and diastolic BP in the range of 93-102 mmHg might be beneficial to reduce the occurrence of poststroke cognitive impairment (PSCI).
• Lower or higher BP after ischaemic stroke was associated with increased risk for PSCI at 3 months.
• Large artery atherosclerosis and total anterior circulation infarct subtypes were associated with increased risk for PSCI.

Why this matters

• Cognitive decline is seen in 24%-58% of patients in early phase of stroke.
• PSCI is associated with higher mortality.

Study design

• Study of 796 patients with acute ischaemic stroke from Stroke Registry database.
• Cognitive function was assessed using the Montreal Cognitive Assessment.
• Funding: Bureau of Science and Technology of Jiangsu Province; Bureau of Health of Jiangsu Province; Ministry of Science and Technology of China.

Key results

• At 3 months, the risk for PSCI was significantly higher in patients with lowest (102-127 mmHg; aOR, 1.83; P=.007) and the highest systolic BP quintiles (171-215 mmHg; aOR, 2.32; P<.001) vs the middle quintile (Q3, 143-158 mmHg).
• Compared with the middle diastolic BP quintile (93-102 mmHg), the risk for PSCI was significantly higher in the first (66-82 mmHg; OR, 1.66; 95% 1.24-2.07), second (83-92 mmHg; OR, 1.58; 95% CI, 1.19-1.98), fourth (103-109 mmHg; OR, 1.51; 95% CI, 1.13-1.89) and fifth diastolic BP quintiles (110-138 mmHg; OR, 2.40; 95% CI, 1.80-3.01).
• Large artery atherosclerosis (aOR, 1.42; P=.031) and total anterior circulation infarct (aOR, 1.68; P=.001) showed significant association with risk for PSCI.

Limitations

• Single-centre study, small sample size, short follow-up period.