![]() Other factors like age and gender differences between the groups might also turn out to be significant associates to the outcome. Putting together, the change in the outcome(cerebral blood flow) was unlikely due to maintaining the blood pressure under 120 mmHg (the study goal), but might be more associated with the baseline difference in the SBP alone or in combination with the overall decrease in the SBP at any level (including below 143 mmHg). But the baseline percentage of the first tertile was significantly higher in the intensive therapy group. Either groups represented no significant change in the proportion of patients in the lowest tertile (=143 mmHg) was modestly more in the intensive therapy group versus the control (4% vs. 4)):399s-402s.Īccording to table 1, the differences in the systolic blood pressure (SBP) tertiles at the baseline versus the completed follow up results are not strictly consistent with the conclusion made. Blood pressure gradients in cerebral arteries: a clue to pathogenesis of cerebral small vessel disease. ![]() Spectral analysis of carotid vs femoral Doppler velocity patterns: a clue to genesis of flow disturbances in cerebral arteries. Blood pressure measurement in the elderly: correlation of arterial stiffness with difference between intra-arterial and cuff pressures. Post-stroke diastolic blood pressure and risk of recurrent vascular events. Diastolic Blood Pressure, Subclinical Myocardial Damage, and Cardiac Events: Implications for Blood Pressure Control. McEvoy JW, Chen Y, Rawlings A, Hoogeveen RC, Ballantyne CM, Blumenthal RS, et al. Risk from low blood pressure in frail older adults: diastolic pressure and pulse pressure are important. Messerli (7) and others commented on the issue in later years, but doctors seem to have forgotten that in old people with stiff arteries, the diastolic pressure measured by cuff may be much higher than the true intra-arterial pressure.”ġ. (8) (At the time I was focusing on the indication for treatment of hypertension, which in those days was a diastolic pressure >90 mmHg). (7) I first described what I called “pseudohypertension”, better called Cuff Artefact, in 1978. Osler wrote in 1892 about the hard radial artery that was still palpable after inflation of a blood pressure cuff. Thus, an old person with stiff arteries might have a blood pressure of 130/55 by cuff, with an even lower true diastolic pressure, at times below thresholds required to perfuse the heart and brain. There is a large pressure gradient in the brain: when the blood pressure in the brachial artery is 117/75 mmHg, it is 113/73 mmHg in the lenticulostriate artery but only 59/39 mmHg in small branches in the posterior parietal subcortex.(6) Virtually all of coronary perfusion (2) and most of cerebral perfusion (5) occurs during diastoleĤ. the true intra-arterial pressure is much lower than the blood pressure measured by a cuff) (4)ģ. People with stiff arteries are more likely to have a large cuff artefact (i.e. People with a wide pulse pressure have stiff arteries Ģ. “McEvoy et al.(2) reported from the ARIC trial that a diastolic pressure 60 mmHg (DBP60) doubled subclinical myocardial ischemia, and Park and Ovbiagele (3)reported from the VISP database that such participants had a 5.85-fold increase in the risk of stroke.ġ. The following comment is quoted from a letter to Age & Aging. I wonder if those were patients with a diastolic pressure 60 mmHg. In their Figure 3, some cases had a reduction of CBF with intensive blood pressure lowering.
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