Author Interviews, Blood Pressure - Hypertension, Brigham & Women's - Harvard, JAMA, Stroke / 16.04.2018
With Brain Microbleeds, Can Patients Tolerate Lower Blood Pressure?
MedicalResearch.com Interview with:
Dr. Joshua Goldstein MD, PhD
J. Philip Kistler Stroke Research Center
Division of Neurocritical Care and Emergency Neurology, Department of Neurology MGH
Harvard Medical School, Boston Department of Emergency Medicine
Massachusetts General Hospital
for the Antihypertensive Treatment of Acute Cerebral Hemorrhage 2 (ATACH-2) and the Neurological Emergencies Treatment Trials (NETT) Network Investigators
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: It’s hard to know how aggressively to lower blood pressure in acute intracerebral hemorrhage (ICH). Randomized controlled trials have been conflicting. We thought that we could use the presence of severe small vessel disease (SVD) - manifested by microbleeds seen on brain magnetic resonance imaging (MRI) – to guide treatment decisions. On the one hand, those with severe SVD may be most vulnerable to continued bleeding, and specifically need more intensive blood pressure lowering. On the other hand, if they have impaired regulation of cerebral blood flow, they might be harmed by rapid drops in blood pressure, and maybe we have to be more careful with them.
To answer this, we performed a subgroup analysis of the multi-centre ATACH-2 clinical trial of intensive blood pressure lowering. This was the first study to assess the effect of randomized acute stroke treatment on patients with more severe SVD, manifested by microbleeds. We found that no matter what your small vessel disease burden on MRI, you’ll respond the same to early blood pressure management.
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MedicalResearch.com Interview with:
Dr. Wanpen Vongpatanasin MD
Program Director, Hypertension Fellowship Program
Professor of Internal Medicine
Director of the University of Texas Southwestern Hypertension Program
Medical Research: What is the background for this study? What are the main findings?
Dr. Vongpatanasin: Home blood pressure measurement may reveal very different number when compared to clinic blood pressure in hypertensive patients. This difference can manifest as white coat hypertension (White Coat Hypertension; elevated office blood pressure with normal ambulatory or home blood pressure), or masked hypertension (MH; elevated ambulatory or home BP with normal office blood pressure). Although numerous epidemiological studies from Europe and Asia have shown increased cardiovascular risks associated with White Coat Hypertension and masked hypertension, previous studies have not addressed cardiovascular outcomes associated with White Coat Hypertension and masked hypertension in the general population in the United States.
We found that participants in the Dallas Heart Study, a multiethnic populational-based study in the Dallas County, both White Coat Hypertension and MH are associated with increased aortic stiffness and markers of kidney damage when compared to the group with normal blood pressure both at home and in the clinic. Furthermore, both white coat hypertension and masked hypertension are associated with increased risk of cardiovascular events, including coronary heart disease, stroke, atrial fibrillation, heart failure, and cardiovascular death over a median follow-up period of 9 years.
