Poor Blood-Pressure Control Related to More Lacunar Strokes at Earlier Age
While elevated blood pressure is a well-established risk factor for stroke, there has been debate regarding the roll of elevated blood pressure in lacunar stroke with some studies suggesting that hypertension in those with lacunar stroke was the same as in the general population.
Results from the longitudinal Oxford Vascular study (Neurology. 2018;90(20):1732-1741) provide strong evidence suggesting elevated blood pressure accelerates the causes of lacunar stroke, and that rapid control of blood pressure is a critical need in stroke prevention, particularly in younger patients. Of 2,085 patients who had stroke or a transient ischemic attack (TIA), 309 had lacunar events. When stratified by age, patients under age 65 who had lacunar or nonlacunar events were equally likely to have a diagnosis of hypertension. However, the mean blood pressure (uncontrolled hypertension) and maximum blood pressure were both significantly higher in patients with lacunar stroke, primarily because of higher mean blood pressure in the 5 years prior to the event. Importantly, long-term and recent elevated diastolic blood pressure was associate with lacunar events at all ages.
These results emphasize the importance of treating and controlling hypertension in a timely way after diagnosis. The study authors also suggest that control of diastolic blood pressure is important for prevention of small vessel disease, that is associated with white matter changes, microbleeds, and cognitive decline.