Cerebrovascular risks with rapid blood pressure lowering in the absence of hypertensive emergency

Miller, Joseph; Calo, Sean; Reed, Brian; Thompson, Richard; Nahab, Bashar; Wu, Evan; Chaudhry, Kaleem; Levy, Phillip D.

doi:10.1016/j.ajem.2018.08.052

Cited by 2 publications

(4 citation statements)

References 25 publications

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“…27–54,56,57 Six studies included participants with dementia or MCI. 26,27,29,31,54,55 Fifteen studies used a calcium channel blocker, 26,29,31,32,34,36,38,39,43,44,47,48,52,55,57 but our data also included angiotensin receptor blockers, 27,31,36,49,50 diuretics, 27,28,36,38–40,42,51,52 angiotensin-converting enzyme inhibitors, 27,30,36,37,41,42,44,53,54,56 β blockers, 28,30,37,45,46,48 and α blockers. 36,44,48 Measurement techniques for CBF were 133-Xenon inhalation technique, 28,33,37–39,44–46,53,56 arterial spin labeling, 26,35,36 single photon emission computed tomography, 29,31,32,40,42,49,51,52,54 transcranial Doppler, 26,27,48,57 and PET.…”

Section: Resultsmentioning

confidence: 99%

“…Thirty studies included participants with hypertension. 27–54,56,57 Six studies included participants with dementia or MCI. 26,27,29,31,54,55 Fifteen studies used a calcium channel blocker, 26,29,31,32,34,36,38,39,43,44,47,48,52,55,57 but our data also included angiotensin receptor blockers, 27,31,36,49,50 diuretics, 27,28,36,38–40,42,51,52 angiotensin-converting enzyme inhibitors, 27,30,36,37,41,42,44,53,54,56 β blockers, 28,30,37,45,46,48 and α blockers.…”

Section: Resultsmentioning

confidence: 99%

“…Fourteen studies were randomized controlled trial’s, 26–39 one was a nonrandomized trial (comparing hydrochlorothiazide with no medication without randomizing the groups) 40 and seventeen were prestudies and poststudies, 41–57 6 of which used a cross-over design. 28,37–40,46 Twenty-three studies investigated chronic effects of AHT, 26–32,34–36,40–42,45–47,49–51,53,54 5 investigated acute effects, 43,44,48,55 and 4 studies investigated both. 33,39,52,57 Sample sizes ranged from 6 to 673 participants with the mean age ranging from 50 to 79 years.…”

Section: Resultsmentioning

confidence: 99%

“…Fourteen studies were randomized controlled trial's, [26][27][28][29][30][31][32][33][34][35][36][37][38][39] one was a nonrandomized trial (comparing hydrochlorothiazide with no medication without randomizing the groups) 40 and seventeen were prestudies and poststudies, [41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57] 6 of which used a cross-over design. 28,[37][38][39][40]46 Twenty-three studies investigated chronic effects of AHT, [26][27][28][29][30][31][32][34][35][36][40]…”

Section: Study Characteristicsmentioning

confidence: 99%

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Effect of Antihypertensive Treatment on Cerebral Blood Flow in Older Adults: a Systematic Review and Meta-Analysis

et al. 2022

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Background: In older age, the benefits of antihypertensive treatment (AHT) become less evident, with greater associated risk. Of particular concern is compromising cerebral blood flow (CBF), especially in those with cognitive impairment. Methods: We created a synthesis of the published evidence by searching multiple electronic databases from 1970 to May 2021. Included studies had participants with mean age ≥50 years, hypertension and cognitive impairment, and assessed CBF before and after initiating AHT. Two authors independently determined eligibility and extracted data. Study quality was assessed using The Risk of Bias in Nonrandomized Studies of Interventions tool. We summarized study characteristics (qualitative synthesis) and performed random-effects meta-analyses (quantitative synthesis). Results: Thirty-two studies (total n=1306) were included, of which 23 were eligible for meta-analysis. In line with the qualitative synthesis, the meta-analysis indicated no effect of AHT initiation on CBF (standardized mean difference, 0.08 [95% CI, −0.07 to 0.22]; P =0.31, I 2 =42%). This was consistent across subgroups of acute versus chronic AHT, drug class, study design, and CBF measurement. Subgroups by age demonstrated an increase in CBF after AHT in those aged >70 years (standardized mean difference, 4.15 [95% CI, 0.16–8.15]; P =0.04, I 2 =42%), but not in those aged 50 to 65 and 65 to 70 years (standardized mean difference, 0.18 [95% CI,−2.02 to 2.38]; P =0.87, I 2 =49%; standardized mean difference, 1.22 [95% CI, −0.45 to 2.88]; P =0.15, I 2 =68%). Overall, risk of bias was moderate-to-high and quality of evidence (Grading of Recommendations Assessment, Development and Evaluation) was very low, reflecting the observational nature of the data. Conclusions: Accepting the observed limitations, current evidence does not suggest a harmful effect of AHT on CBF. Concerns over CBF should not preclude treatment of hypertension.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

See 2 more Smart Citations

Effect of Antihypertensive Treatment on Cerebral Blood Flow in Older Adults: a Systematic Review and Meta-Analysis

et al. 2022

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Evaluation and management of hypertensive emergency

Miller,

Hrabec,

Krishnamoorthy

et al. 2024

BMJ

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Hypertensive emergencies cause substantial morbidity and mortality, particularly when acute organ injury is present. Careful and effective strategies to reduce blood pressure and diminish the effects of pressure-mediated injury are essential. While the selection of specific antihypertensive medications varies little across different forms of hypertensive emergencies, the intensity of blood pressure reduction to the target pressure differs substantially. Treatment hinges on balancing the positive effects of lowering blood pressure with the potential for negative effects of organ hypoperfusion in patients with altered autoregulatory mechanisms. When patients do not have acute organ injury in addition to severe hypertension, they benefit from a conservative, outpatient approach to blood pressure management. In all cases, long term control of blood pressure is paramount to prevent recurrent hypertensive emergencies and improve overall prognosis. This review discusses the current evidence and guidelines on the evaluation and management of hypertensive emergency.

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Cerebrovascular risks with rapid blood pressure lowering in the absence of hypertensive emergency

Cited by 2 publications

References 25 publications

Effect of Antihypertensive Treatment on Cerebral Blood Flow in Older Adults: a Systematic Review and Meta-Analysis

Effect of Antihypertensive Treatment on Cerebral Blood Flow in Older Adults: a Systematic Review and Meta-Analysis

Evaluation and management of hypertensive emergency

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