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.

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 August 20, 2014 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 August 20, 2014).

Share This




More Health & Medicine News

Wednesday, August 20, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Ebola-Hit Sierra Leone's Freetown a City on Edge

Ebola-Hit Sierra Leone's Freetown a City on Edge

AFP (Aug. 19, 2014) Residents of Sierra Leone's capital voice their fears as the Ebola virus sweeps through west Africa. Duration: 00:56 Video provided by AFP
Powered by NewsLook.com
101-Year-Old Working Man Has All The Advice You Need

101-Year-Old Working Man Has All The Advice You Need

Newsy (Aug. 19, 2014) Herman Goldman has worked at the same lighting store for almost 75 years. Find out his secrets to a happy, productive life. Video provided by Newsy
Powered by NewsLook.com
Researcher Testing on-Field Concussion Scanners

Researcher Testing on-Field Concussion Scanners

AP (Aug. 19, 2014) Four Texas high school football programs are trying out an experimental system designed to diagnose concussions on the field. The technology is in response to growing concern over head trauma in America's most watched sport. (Aug. 19) Video provided by AP
Powered by NewsLook.com
American Ebola Patient Apparently Improving, Outbreak Is Not

American Ebola Patient Apparently Improving, Outbreak Is Not

Newsy (Aug. 19, 2014) Nancy Writebol, an American missionary who contracted Ebola, is apparently getting better, according to her husband. The outbreak, however, is not. Video provided by Newsy
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:
from the past week

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