Central and cerebral haemodynamic changes after antihypertensive therapy in ischaemic stroke patients: A double-blind randomised trial

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.

Figure 1

Consort flow chart of this study.

Figure 2

Mean changes in brachial, central pressure and cerebral haemodynamic parameters between baseline and 12 weeks. Regardless of similar brachial blood pressure (BP) reduction (a), central systolic BP and central pulse pressure (b) showed significant difference in ARB groups. The pulsatility index on transcranial Doppler (c) after 12 weeks was significantly reduced in valsartan (p = 0.002) and fimasartan groups (p = 0.008). *p < 0.05, **p < 0.01.

Figure 3

Mean changes in augmentation index (a,b) and other systemic parameters (c,d) from baseline. Augmentation index showed reduction only in the ARB groups. However, there were no differences in changes of baPWV and FMD among the three groups. *p < 0.05, **p < 0.01 vs. baseline.

Figure 4

Plasma NT-proBNP level and the contour change of arterial wave reflection. (a) Mean change in plasma NT-proBNP level between baseline and 12 weeks (Mean ± SD). Plasma NT-proBNP level was also significantly lowered in ARB groups after 12-week treatment, only fimasartan group showed significant reduction of plasma NT-proBNP level between baseline and 12 weeks (by paired t-test). (b) The difference in NT-proBNP level according to AIx75 tertile group. Plasma NT-proBNP levels increased with the increase in AIx75 tertile. (c) The contour of arterial wave reflection after 12-week treatment had the lowest trend in fimasartan group, although there were no significant differences in the AUCs of arterial wave reflection (p = 0.267).