Featured Research

from universities, journals, and other organizations

Protocol for stroke patients guided by landmark study

Date:
March 26, 2014
Source:
University of North Carolina School of Medicine
Summary:
Neurologists have long debated how to help prevent certain stroke patients from suffering a second stroke. Now research provides the first evidence for which course of treatment is truly best for patients with poor collateral blood vessel formation near the site of stroke: they should have their blood pressure lowered to normal levels.

William Powers, MD, whose work shows that keeping blood pressure high leads to a four-fold increase in the risk of stroke.
Credit: Max Englund, UNC Health Care

Neurologists have long debated how to help prevent certain stroke patients from suffering a second stroke. Now research from UNC School of Medicine provides the first evidence for which course of treatment is truly best for patients with poor collateral blood vessel formation near the site of stroke: they should have their blood pressure lowered to normal levels.

Related Articles


Many neurologists had suspected that blood pressure should be left high in this group of patients because doctors thought high blood pressure might force blood around the blockage and through collateral vessels, which would be beneficial and, therefore, reduce risk of stroke.

But research from William Powers, MD, the H. Houston Merritt Distinguished Professor and Chair of the Department of Neurology, shows that keeping blood pressure high leads to a four-fold increase in the risk of stroke. The study was published in the journal Neurology March 26.

"Up until now doctors would say to patients, 'well, we think you should do this or we think you should do that,'" Powers said. "But our paper provides the first data that show how patients with poor collateral vessels should be treated."

Andrew Southerland, MD, a neurologist at the University of Virginia who was not involved in the study, said, "This paper clears up a murky question about how to manage blood pressure in these patients. It's a pivotal study in our field."

After a stroke, collateral vessels can help blood flow to an area of the brain that's cut off from its normal blood supply due to a blocked blood vessel. In the 1980s, Powers led PET scan studies that characterized the importance of these collateral vessels. His team showed that patients with poor collateral flow faced six times the risk of a suffering a second stroke than did patients with good collateral vessel formation. But how to treat those patients with poor collaterals remained debatable.

For most stroke patients, doctors agree that reducing blood pressure to the normal range is best. "We have very good studies showing that normalizing blood pressure works," Powers said. "But some doctors argue that reducing blood pressure in patients with poor collaterals would be dangerous."

Using PET scan data of 91 patients with poor collateral blood flow, Powers found that 40 had an average blood pressure of less than 130/85 during the two years after stroke. Fifty-one had blood pressures above that. Powers then found that just three of the 40 patients with "normal" blood pressure had a second stroke. But 10 of the 51 patients with high blood pressure suffered a second stroke.

The study found that lowering blood pressure reduced the risk of a second stroke by 22 percent. "That's impressive," said Southerland. "That's a huge absolute risk reduction that we don't often see in this field."

Powers said, "The idea that you should let blood pressure ride high to prevent a second stroke in these patients turns out to be completely wrong. You should treat their blood pressure just like you should treat everybody else who had a stroke to reduce the risk of a second one."


Story Source:

The above story is based on materials provided by University of North Carolina School of Medicine. Note: Materials may be edited for content and length.


Journal Reference:

  1. W. J. Powers, W. R. Clarke, R. L. Grubb, T. O. Videen, H. P. Adams, C. P. Derdeyn. Lower stroke risk with lower blood pressure in hemodynamic cerebral ischemia. Neurology, 2014; 82 (12): 1027 DOI: 10.1212/WNL.0000000000000238

Cite This Page:

University of North Carolina School of Medicine. "Protocol for stroke patients guided by landmark study." ScienceDaily. ScienceDaily, 26 March 2014. <www.sciencedaily.com/releases/2014/03/140326101531.htm>.
University of North Carolina School of Medicine. (2014, March 26). Protocol for stroke patients guided by landmark study. ScienceDaily. Retrieved January 29, 2015 from www.sciencedaily.com/releases/2014/03/140326101531.htm
University of North Carolina School of Medicine. "Protocol for stroke patients guided by landmark study." ScienceDaily. www.sciencedaily.com/releases/2014/03/140326101531.htm (accessed January 29, 2015).

Share This


More From ScienceDaily



More Health & Medicine News

Thursday, January 29, 2015

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Oxfam Calls for Massive Aid for Ebola-Hit West Africa

Oxfam Calls for Massive Aid for Ebola-Hit West Africa

AFP (Jan. 29, 2015) Oxfam International has called for a multi-million dollar post-Ebola "Marshall Plan", with financial support given by wealthy countries, to help Guinea, Sierra Leone and Liberia to recover. Duration: 01:10 Video provided by AFP
Powered by NewsLook.com
Are We Winning The Fight Against Ebola?

Are We Winning The Fight Against Ebola?

Newsy (Jan. 29, 2015) The World Health Organization announced the fight against Ebola has entered its second phase as the number of cases per week has steadily dropped. Video provided by Newsy
Powered by NewsLook.com
Calif. Health Officials Campaign Against E-Cigarettes

Calif. Health Officials Campaign Against E-Cigarettes

Newsy (Jan. 29, 2015) The California Health Department says e-cigarettes are a public health risk for both smokers and those who inhale e-cig smoke secondhand. Video provided by Newsy
Powered by NewsLook.com
Measles Scare Sends 66 Calif. Students Home

Measles Scare Sends 66 Calif. Students Home

AP (Jan. 29, 2015) Officials say 66 students at a Southern California high school have been told to stay home through the end of next week because they may have been exposed to measles and are not vaccinated. (Jan. 29) Video provided by AP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins