title: Lower stroke risk with lower blood pressure in hemodynamic cerebral ischemia.
abstract: OBJECTIVE
  To determine whether strict blood pressure (BP) control is the best medical management for patients with symptomatic carotid artery occlusion and hemodynamic cerebral ischemia.
  
  
  METHODS
  In this prospective observational cohort study, we analyzed data from 91 participants in the nonsurgical group of the Carotid Occlusion Surgery Study (COSS) who had recent symptomatic internal carotid artery occlusion and hemodynamic cerebral ischemia manifested by ipsilateral increased oxygen extraction fraction. The target BP goal in COSS was ≤130/85 mm Hg. We compared the occurrence of ipsilateral ischemic stroke during follow-up in the 41 participants with mean BP ≤130/85 mm Hg to the remaining 50 with higher BP.
  
  
  RESULTS
  Of 16 total ipsilateral ischemic strokes that occurred during follow-up, 3 occurred in the 41 participants with mean follow-up BP of ≤130/85 mm Hg, compared to 13 in the remaining 50 participants with mean follow-up BP >130/85 mm Hg (hazard ratio 3.742, 95% confidence interval 1.065-13.152, log-rank p = 0.027).
  
  
  CONCLUSIONS
  BPs ≤130/85 mm Hg were associated with lower subsequent stroke risk in these patients.
  
  
  METHODS
  This study provides Class III evidence that control of hypertension ≤130/85 mm Hg is associated with a reduced risk of subsequent ipsilateral ischemic stroke in patients with recently symptomatic carotid occlusion and hemodynamic cerebral ischemia (increased oxygen extraction fraction).
authors: From the Department of Neurology (W.J.P.), University of North Carolina School of Medicine, Chapel Hill; Clinical Trials Statistics and Data Management Center (W.R.C.), University of Iowa College of Public Health, Iowa City; Departments of Neurological Surgery (R.L.G., C.P.D.), Radiology (R.L.G., T.O.V., C.P.D.), and Neurology (T.O.V., C.P.D.), Washington University School of Medicine, St. Louis, MO; and the Department of Neurology (H.P.A.), University of Iowa Carver School of Medicine, Iowa City.
authors: William J
authors: WJ
authors: Powers
authors: William R
authors: WR
authors: Clarke
authors: Robert L
authors: RL
authors: Grubb
authors: Tom O
authors: TO
authors: Videen
authors: Harold P
authors: HP
authors: Adams
authors: Colin P
authors: CP
authors: Derdeyn
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D001794:Blood Pressure / Q000502:physiology; D001795:Blood Pressure Determination; D002545:Brain Ischemia / Q000150:complications / Q000209:etiology; D002340:Carotid Artery Diseases / Q000150:complications; D015331:Cohort Studies; D019468:Disease Management; D005500:Follow-Up Studies; D007839:Functional Laterality / Q000502:physiology; D006973:Hypertension / Q000150:complications; D011446:Prospective Studies; D012306:Risk; D020521:Stroke / Q000209:etiology