title: Higher Stroke Risk with Lower Blood Pressure in Hemodynamic Vertebrobasilar Disease: Analysis from the VERiTAS Study.
abstract: BACKGROUND
  Despite concerns regarding hypoperfusion in patients with large-artery occlusive disease, strict blood pressure (BP) control has become adopted as a safe strategy for risk reduction of stroke. We examined the relationship between BP control, blood flow, and risk of subsequent stroke in the prospective Vertebrobasilar Flow Evaluation and Risk of Transient Ischemic Attack and Stroke (VERiTAS) study.
  
  
  METHODS
  The VERiTAS study enrolled patients with recent vertebrobasilar (VB) transient ischemic attack or stroke and ≥50% atherosclerotic stenosis or occlusion of vertebral or basilar arteries. Hemodynamic status was designated as low or normal based on quantitative magnetic resonance angiography. Patients underwent standard medical management and follow-up for primary outcome event of VB territory stroke. Mean BP during follow-up (<140/90 versus ≥140/90 mm Hg) and flow status were examined relative to subsequent stroke risk using Cox proportional hazards analysis.
  
  
  RESULTS
  The 72 subjects had an average of 3.8 ± 1.2 BP recordings over 20 ± 8 months of follow-up; 39 (54%) had mean BP of<140/90 mm Hg. The BP groups were largely comparable for baseline demographics, risk factors, and stenosis severity. Comparing subgroups stratified by BP and hemodynamic status, we found that patients with both low flow and BP <140/90 mm Hg (n = 10) had the highest risk of subsequent stroke, with hazard ratio of 4.5 (confidence interval 1.3-16.0, P = .02), compared with the other subgroups combined.
  
  
  CONCLUSIONS
  Among a subgroup of patients with VB disease and low flow, strict BP control (BP <140/90) may increase the risk of subsequent stroke.
authors.affiliation: Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois. Electronic address: hanjani@uic.edu.
authors.forename: Sepideh
authors.initials: S
authors.lastname: Amin-Hanjani
authors.affiliation: Department of Neurology, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Tanya N
authors.initials: TN
authors.lastname: Turan
authors.affiliation: Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Xinjian
authors.initials: X
authors.lastname: Du
authors.affiliation: Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Dilip K
authors.initials: DK
authors.lastname: Pandey
authors.affiliation: Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Linda
authors.initials: L
authors.lastname: Rose-Finnell
authors.affiliation: Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, Illinois; Department of Mathematics & Computer Science, Lake Forest College, Lake Forest, Illinois.
authors.forename: DeJuran
authors.initials: D
authors.lastname: Richardson
authors.affiliation: Departments of Neurology and Epidemiology, Columbia University, New York, New York.
authors.forename: Mitchell S V
authors.initials: MS
authors.lastname: Elkind
authors.affiliation: Departments of Neurosurgery and Neurology, Washington University in St. Louis, St. Louis, Missouri.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Zipfel
authors.affiliation: Neurovascular Imaging and Research Core and Department of Neurology, University of California Los Angeles, Los Angeles, California.
authors.forename: David S
authors.initials: DS
authors.lastname: Liebeskind
authors.affiliation: Department of Medicine, Division of Neurology, University of Toronto, Toronto, Canada.
authors.forename: Frank L
authors.initials: FL
authors.lastname: Silver
authors.affiliation: Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Kasner
authors.affiliation: Department of Translational Science & Molecular Medicine, Michigan State University College of Human Medicine, East Lansing, Michigan; Mercy Health Hauenstein Neurosciences, Grand Rapids, Michigan.
authors.forename: Philip B
authors.initials: PB
authors.lastname: Gorelick
authors.affiliation: Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Fady T
authors.initials: FT
authors.lastname: Charbel
authors.affiliation: Departments of Neurosurgery and Neurology, Washington University in St. Louis, St. Louis, Missouri; Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
authors.forename: Colin P
authors.initials: CP
authors.lastname: Derdeyn
mesh_terms: D000368:Aged; D001794:Blood Pressure; D001921:Brain / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D003251:Constriction, Pathologic / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D014715:Vertebrobasilar Insufficiency / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology
keywords: Blood flow; blood pressure; magnetic resonance angiography; magnetic resonance imaging; stroke; vertebrobasilar disease