biostudies-literatureUnknown6(3)Mazzucco SWolfson FoundationNational Institute for Health Research Oxford Biomedical Research CentreWellcome Trust<h4>Introduction</h4>There is limited knowledge of the effects of blood pressure (BP) lowering on cerebral haemodynamics after transient ischaemic attack (TIA) and non-disabling stroke, particularly at older ages. We aimed to evaluate changes in transcranial Doppler (TCD) haemodynamic indices in patients undergoing early blood pressure lowering after TIA/non-disabling stroke, irrespective of age.<h4>Patients and methods</h4>Among consecutive eligible patients attending a rapid-access clinic with suspected TIA/non-disabling stroke and no evidence of extra/intracranial stenosis, hypertensive ones underwent intensive BP-lowering guided by daily home telemetric blood pressure monitoring (HBPM). Clinic-based BP, HBPM, End-tidal CO₂ and bilateral middle cerebral artery (MCA) velocity on TCD were compared in the acute setting versus one-month follow-up; changes were stratified by baseline hypertension (clinic-BP≥140/90) and by age (<65, 65-79 and ≥80).<h4>Results</h4>In 697 patients with repeated TCD measures, mean/SD baseline systolic-BP (145.0/21.3 mmHg) was reduced by an average of 11.3/19.9 mmHg (<i>p</i> < 0.0001) at one-month (133.7/17.4 mmHg), driven by patients hypertensive at baseline (systolic-BP change = -19.0/19.2 mmHg, <i>p</i> < 0.001; vs -0.5/15.4, <i>p</i> = 0.62 in normotensives). Compared with baseline, a significant change was observed at one-month only in mean/SD MCA end diastolic velocity (EDV) (0.77/7.26 cm/s, <i>p</i> = 0.005) and in resistance index (RI) (-0.005/0.051, <i>p</i> = 0.016), driven by hypertensive patients (mean/SD EDV change: 1.145/6.96 cm/s <i>p</i> = 0.001, RI change -0.007/0.06, <i>p</i> = 0.014). Findings were similar at all ages (EDV change - p_trend=0.357; RI change - p_trend=0.225), including 117 patients aged ≥80. EDV and RI changes were largest in 100 patients with clinic systolic-BP decrease ≥30 mmHg (mean/SD EDV change = 2.49/7.47 cm/s, <i>p</i> = 0.001; RI change -0.024/0.063, <i>p</i> < 0.0001).<h4>Conclusion</h4>There was no evidence of worsening of TCD haemodynamic indices associated with BP-lowering soon after TIA/non-disabling stroke, irrespective of age and degree of BP reduction. In fact, EDV increase and RI decrease observed after treatment of hypertensive patients suggest a decrease in distal vascular resistance.European stroke journal245-253https://www.ebi.ac.uk/biostudies/studies/S-EPMC8564162biostudies-literatureAge-specific cerebral haemodynamic effects of early blood pressure lowering after transient ischaemic attack and non-disabling stroke.PMC8564162Oxford Vascular Study Phenotyped cohortMazzucco SBrunelli NRothwell PMBinney LEMcGurgan IJLi LTuna MAfalseAge-specific cerebral haemodynamic effects of early blood pressure lowering after transient ischaemic attack and non-disabling stroke.<h4>Introduction</h4>There is limited knowledge of the effects of blood pressure (BP) lowering on cerebral haemodynamics after transient ischaemic attack (TIA) and non-disabling stroke, particularly at older ages. We aimed to evaluate changes in transcranial Doppler (TCD) haemodynamic indices in patients undergoing early blood pressure lowering after TIA/non-disabling stroke, irrespective of age.<h4>Patients and methods</h4>Among consecutive eligible patients attending a rapid-access clinic with suspected TIA/non-disabling stroke and no evidence of extra/intracranial stenosis, hypertensive ones underwent intensive BP-lowering guided by daily home telemetric blood pressure monitoring (HBPM). Clinic-based BP, HBPM, End-tidal CO₂ and bilateral middle cerebral artery (MCA) velocity on TCD were compared in the acute setting versus one-month follow-up; changes were stratified by baseline hypertension (clinic-BP≥140/90) and by age (<65, 65-79 and ≥80).<h4>Results</h4>In 697 patients with repeated TCD measures, mean/SD baseline systolic-BP (145.0/21.3 mmHg) was reduced by an average of 11.3/19.9 mmHg (<i>p</i> < 0.0001) at one-month (133.7/17.4 mmHg), driven by patients hypertensive at baseline (systolic-BP change = -19.0/19.2 mmHg, <i>p</i> < 0.001; vs -0.5/15.4, <i>p</i> = 0.62 in normotensives). Compared with baseline, a significant change was observed at one-month only in mean/SD MCA end diastolic velocity (EDV) (0.77/7.26 cm/s, <i>p</i> = 0.005) and in resistance index (RI) (-0.005/0.051, <i>p</i> = 0.016), driven by hypertensive patients (mean/SD EDV change: 1.145/6.96 cm/s <i>p</i> = 0.001, RI change -0.007/0.06, <i>p</i> = 0.014). Findings were similar at all ages (EDV change - p_trend=0.357; RI change - p_trend=0.225), including 117 patients aged ≥80. EDV and RI changes were largest in 100 patients with clinic systolic-BP decrease ≥30 mmHg (mean/SD EDV change = 2.49/7.47 cm/s, <i>p</i> = 0.001; RI change -0.024/0.063, <i>p</i> < 0.0001).<h4>Conclusion</h4>There was no evidence of worsening of TCD haemodynamic indices associated with BP-lowering soon after TIA/non-disabling stroke, irrespective of age and degree of BP reduction. In fact, EDV increase and RI decrease observed after treatment of hypertensive patients suggest a decrease in distal vascular resistance.2021-01-01T00:00:00Z2021 Sep2026-06-02T18:30:04.787Z2025-04-04T14:53:27.828ZS-EPMC85641623474642010.1177/23969873211039716