Abstract
Central and cerebral haemodynamic parameters can vary under similar brachial blood pressure (BP). We aimed to investigate the effects of antihypertensive agents on central and cerebral haemodynamic parameters in hypertensive patients with ischaemic stroke. The Fimasartan, Atenolol, and Valsartan On haemodynamic paRameters (FAVOR) study was conducted in a prospective, double-blinded manner. One hundred five patients were randomly administered atenolol, valsartan, or fimasartan during 12 weeks. We measured brachial, central, cerebral haemodynamic parameters and plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) levels at baseline and after 12-week. Baseline haemodynamic parameters were balanced among the three groups. Even with similar brachial BP reduction, significantly lower central systolic BP (atenolol; 146.5 ± 18.8 vs. valsartan; 133.5 ± 20.7 vs. fimasartan; 133.6 ± 19.8 mmHg, p = 0.017) and augmentation index values (89.8 ± 13.2 vs. 80.6 ± 9.2 vs. 79.2 ± 11.6%; p = 0.001) were seen in the angiotensin receptor blockers (ARBs) groups. The pulsatility index on transcranial Doppler was significantly reduced in valsartan (p = 0.002) and fimasartan group (p = 0.008). Plasma NT-proBNP level was also significantly decreased in ARB groups, especially for the fimasartan group (37.8 ± 50.6 vs. 29.2 ± 36.9 vs.19.2 ± 27.8 pg/mL; p = 0.006). These findings suggest that short-term ARB administration would be favourable for ischaemic stroke patients with hypertension, permitting effective reduction of central pressure and dampening of cerebral pulsatility.
Highlights
Hypertension is one of the most important modifiable risk factors in the secondary prevention of stroke[1]
Patients were eligible for this trial if they satisfied all of the following inclusion criteria: presenting with neurological deficits within 48 hours of onset; ischaemic stroke confirmed by diffusion weighted imaging[16] or transient ischaemic attack[17]; over 30 years of age; no deterioration of NIH stroke scale (NIHSS) score for at least 48 hours after admission; diagnosed with hypertension[18] or who were already taking antihypertensive agents before hospitalization
As compared with the atenolol group, the short-term use of angiotensin receptor blockers (ARBs) had more beneficial effects on central blood pressure (BP) and cerebral pulsatility, even though similar reductions were seen on brachial BP in patients with ischaemic stroke
Summary
Hypertension is one of the most important modifiable risk factors in the secondary prevention of stroke[1]. Renin-Angiotensin System (RAS) blockades—angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blockers (ARBs) were frequently prescribed antihypertensive agents for stroke patients in anticipation of “beyond blood pressure (BP) lowering” effect that attenuate the vicious cascade such as vascular remodeling, endothelial dysfunction, oxidative stress and inflammation[2,3]. Beta-blockers, despite limited effect on prevention of cardiovascular events compared with ARB5, still have been considered for lowering BP due to their minimal influence on cerebral perfusion especially in acute period[6,7]. We aimed to assess the impact of 12-week antihypertensive treatment with ARBs compared to β-blockers on central pressure and cerebral haemodynamics in hypertensive patients with ischaemic stroke under similar brachial BP control
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
