Premium
Two elderly cases of nocturnal onset stroke with stenosis of carotid arteries during the treatment of hypertension
Author(s) -
Watanabe Shintaro,
Narita Junichi,
Kario Kazuomi
Publication year - 2002
Publication title -
geriatrics and gerontology international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.823
H-Index - 57
eISSN - 1447-0594
pISSN - 1444-1586
DOI - 10.1046/j.1444-1586.2002.00036.x
Subject(s) - medicine , blood pressure , ambulatory blood pressure , cardiology , stenosis , stroke (engine) , lisinopril , amlodipine , anesthesia , angiotensin converting enzyme , mechanical engineering , engineering
Two hypertensive elderly patients developed ischemic stroke during night‐time after blood pressure reduction using antihypertensive drugs. Case 1 was a 67‐year‐old man and his blood pressure had been controlled at 120–140/55–80 mmHg by the administration of amlodipine besilate (5 mg per day). At 04:00 hours on 25 August 2000, he experienced left hemiparalysis and was brought to the hospital within 1 h of onset. He had severe stenosis of the right internal carotid artery. His left hemiparalysis showed stepwise worsening, and atherectomy of carotid artery was performed. Ambulatory blood pressure monitoring after the operation demonstrated that his systolic blood pressure fell to a minimum of 74 mmHg while he was asleep. Case 2 was a 69‐year‐old man who had developed nasal bleeding due to blood pressure elevation of 240/80 mmHg in January 2000. Strict blood pressure control using long‐acting nifedipine (40 mg per day) and lisinopril (20 mg per day) was initiated. After his blood pressure had been controlled at 130–140/60–80 mmHg, he suffered sudden left hemiparesis at 01:00 on 4 November 2000, showing complete obstruction of the right internal carotid artery. In a patient with carotid artery stenosis, nocturnal hypotension can cause an ischemic stroke. Ambulatory blood pressure monitoring and carotid ultrasound detecting carotid stenosis would be useful to identify patients with a high risk of stroke among elderly hypertensive patients treated with antihypertensive medication.