London, United Kingdom 2013 Cerebrovasc Dis 2013; 35 (suppl 3)1-854 23 5 Heart and brain 9:10 - 9:20 Transient hypotension: an important cause of infarction in older persons D.J. Ryan1, J.F.M Meaney2, A.J. Fagan3, R.A. Kenny4, J.A. Harbison5 Stroke Department, St. James Hospital, Dublin, IRELAND1,Radiology Department, St. James Hospital, Dublin, IRELAND2, Radiology Department, St. James Hospital, Dublin, IRE-LAND3, Falls and Blackouts unit, St. James Hospital, Dublin, IRELAND4, Stroke Department, St. James Hospital, Dublin, IRELAND5 Older, frail patients may utilise higher baseline blood pressures to maintain cerebral perfusion. Anti-hypertensive therapy may be harmful in this cohort. We investigated whether episodic hy-potension, while harmless in the young, may cause tissue infarction in the old. Over 22-months, all acute strokes were prospectively screened for presence of syncope or pre-syncope at stroke onset. All with severe large vessel stenosis were excluded, while cases were referred for syncope unit investigation. All underwent 1.5T MRI acutely, and suspected border-zone infarcts (BZI) were confirmed through mathlab-derived perfusion software (fig. 1). Each case, and three age and gender matched stroke controls, underwent 5-minute phasic beat-to-beat blood pressure assessment. Thirty-one of 596 stroke patients described presyncope or syncope at stroke onset and had pat-ent large vessels (5.2% of all strokes). The mean age was 74 yrs. Seventeen (54.8%) patients were on antihypertensive agents at symptom onset. Eighteen (58%) described a TIA rather than a stroke. All reported orthostatic-related hypotensive symptoms for a median of 4 years (IQR 13.5), occurring 1.33 times/month (IQR 7.6) and were diagnosed with a hypotensive disorder; 18 with vasovagal syncope through head-up tilt symptom reproduction, 8 with orthostatic hy-potension and 5 with cardiac syncope. 15 patients had an acute infarct on MRI, 11 of which were a BZI (73%). The BZI group were significantly older than the non-BZI group, 79yrs vs 65 yrs p=0.002. Compared with 93 stroke controls, cases exhibited higher baseline blood pres-sures (141mmhg vs 126mmhg p=0.02) but also exhibited a trend towards greater variability (6.7mmhg vs 5.51, p=0.06). Older patients that report hypotensive symptoms are susceptible to hypotension-related border-zone infarction, even though their baseline blood pressures are high. Caution is advised regard-ing aggressive antihypertensive therapy in this group.
Karger_ESC London_2013
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