Article Commentary: “Effects of Blood Pressure in the Early Phase of Ischemic Stroke and Stroke Subtype on Poststroke Cognitive Impairment”
Kara Jo Swafford, MD
He M, Wang J, Liu N, Xiao X, Geng S, Meng P, et al. Effects of Blood Pressure in the Early Phase of Ischemic Stroke and Stroke Subtype on Poststroke Cognitive Impairment. Stroke. 2018
Poststroke cognitive impairment (PSCI) is common, having a prevalence between 24% and 58% at 3 months following the acute event. Symptoms can range from mild cognitive impairment to severe dementia and is associated with higher morbidity and mortality. Patient demographics, vascular risk factors and stroke subtypes may help predict development of PSCI.
Hypertension is an important factor that increases the risk for PSCI by causing cerebrovascular dysautoregulation, leading to impaired cortical function. Hypotension can also worsen prognosis, leading to impairment of cognition by reducing cerebral blood flow. This suggests a U-shaped relationship between blood pressure and stroke outcome. Regulation of blood pressure is vital for cerebral perfusion and preventing further neuronal injury. This is why identifying the optimal blood pressure range becomes important in the early phase after ischemic stroke. There is, however, no clear consensus on optimal blood pressure levels to reduce the risk of PSCI. There are also little data on how stroke subtypes relate to PSCI.