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Intensive Blood Pressure Control in Ischaemic Stroke Patients With Severe Cerebral Small Vessel Disease

Primary Purpose

Small Vessel Cerebrovascular Disease, Stroke

Status
Recruiting
Phase
Not Applicable
Locations
Hong Kong
Study Type
Interventional
Intervention
Intensive treatment
Standard treatment
Sponsored by
The University of Hong Kong
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Small Vessel Cerebrovascular Disease focused on measuring Stroke, Small Vessel Disease, Cerebral blood flow, Cognition, Elderly

Eligibility Criteria

50 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Aged ≥50 Chinese ethnicity History of TIA/ischaemic stroke Underlying severe cerebral SVD as evidenced by brain MRI with total SVD score ≥3 Underlying hypertension (defined as either SBP >140mmHg and taking no more than two anti-hypertensive agents, or SBP between 130-140mmHg and on at least one and not more than three anti-hypertensive agents) Able to provide written informed consent Able to perform study cognitive assessments Modified Rankin Scale (mRS) ≤3 Expected life expectancy >2 years Exclusion Criteria: Unable to, or unwilling to consent TIA/ischaemic stroke within three months (to avoid confounding effects of recovery on cognition from recent stroke) Brain MR angiogram showing significant symptomatic or asymptomatic carotid, vertebral or intracranial large artery stenosis ≥50% as measured using the North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria Cortical infarction >2cm in diameter Paroxysmal or permanent atrial fibrillation Known single gene disorder causing cerebral SVD, e.g. cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) Symptomatic postural hypotension Moderate- and severe-stage dementia with Montreal Cognitive Assessment (MOCA)-HK score <10 Moderate and severe depressive symptoms with Patient Health Questionnaire-9 score ≥10 Known secondary hypertension, e.g. hypertension is due to established obstructive sleep apnoea, renal parenchymal disease, renal artery stenosis, primary aldosteronism etc. Unable to complete cognitive assessments mRS >3 Life expectancy of less than 2 years

Sites / Locations

  • University of Hong KongRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Other

Other

Arm Label

Intensive Treatment Group

Standard Treatment Group

Arm Description

SBP target 120-129 mmHg

SBP target 130-140 mmHg

Outcomes

Primary Outcome Measures

Cerebral Blood Flow
Change in whole-brain CBF as measured using MRI ASL at end of study (1 year) compared to baseline.

Secondary Outcome Measures

Grey Matter - Cerebral Blood Flow
Change in Grey Matter CBF as measured using MRI ASL at end of study (1 year) compared to baseline.
White Matter - Cerebral Blood Flow
Change in white matter CBF as measured using MRI ASL at end of study (1 year) compared to baseline.
Structural Connectivity
Change in structural connectivity CBF as measured using MRI DTI at end of study (1 year) compared to baseline.
Cognitive Function - MoCA
Change in MoCA Score at end of study (1 year)
Cognitive Function - Stroop colour-word test
Change in Stroop colour-word test Score at end of study (1 year)
Cognitive Function - Digit Symbol Coding test
Change in Digital Symbol Coding test Score at end of study (1 year)

Full Information

First Posted
January 10, 2023
Last Updated
February 2, 2023
Sponsor
The University of Hong Kong
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1. Study Identification

Unique Protocol Identification Number
NCT05690997
Brief Title
Intensive Blood Pressure Control in Ischaemic Stroke Patients With Severe Cerebral Small Vessel Disease
Official Title
Effect of Intensive Blood Pressure Control on Cerebral Blood Flow and Cognition in Ischaemic Stroke Patients With Severe Cerebral Small Vessel Disease
Study Type
Interventional

2. Study Status

Record Verification Date
February 2023
Overall Recruitment Status
Recruiting
Study Start Date
January 9, 2023 (Actual)
Primary Completion Date
June 2024 (Anticipated)
Study Completion Date
June 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
The University of Hong Kong

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Objectives: Cerebral small vessel disease (SVD) is a common disease in patients with ischemic stroke and the most common cause of vascular dementia. Blood pressure (BP)-lowering is generally considered neuroprotective. Nevertheless, in patients with severe SVD burden, the optimal BP target is uncertain. Hypothesis: BP-lowering to a systolic BP of 120-129mmHg in ischemic stroke patients with severe SVD is not associated with impaired cerebral perfusion, nor does it associate with worsening of structural connectivity and cognitive function. Design and subjects: One-year trial where patients aged ≥50 with a history of ischaemic stroke and severe cerebral SVD will be randomised (1:1) to a systolic BP target of 120-129mmHg versus 130-140mmHg. Study instruments: At baseline and one-year, all subjects will receive a brain magnetic resonance imaging (MRI) to evaluate their cerebral blood flow (CBF) and white matter integrity. They will also receive neuropsychological batteries to evaluate cognitive functioning. In addition, subjects will receive home BP monitoring with periodic medication changes prescribed by medical doctor to ensure the target BP is achieved. Main outcome measures: Primary end-point is the change in CBF. Secondary end-points include changes in structural connectivity and cognitive performance.
Detailed Description
Cerebral small vessel disease (SVD) is a common disease in patients with ischemic stroke and the most common cause of vascular dementia. The global burden of cerebral SVD is high and strategies to better prevent and manage cerebral SVD is urgently needed. Whilst blood pressure (BP) lowering is considered neuroprotective in patients with cerebral SVD, the optimal BP target in ischaemic stroke patients with severe SVD remains uncertain. Therefore, this randomised clinical trial aims to investigate whether two selected systolic blood pressure targets [systolic BP (SBP) 120-129mmHg versus 130-140mmHg] have different effects on cerebral blood flow and white matter integrity (structural connectivity) detected by magnetic resonance imaging (MRI) of the brain, as well as on cognition, over a one-year intervention period. Chinese patients aged ≥50 with a prior history of TIA/ischaemic stroke fitting the inclusion and exclusion criteria will be recruited. At baseline, recruited subjects will undergo clinical and cognitive assessments. Blood pressure will be measured at clinic with an automated BP measurement system. A baseline non-contrast MRI of the brain will be arranged. The non-contrast MRI and cognitive assessments will be repeated at approximately 1 year after recruitment into the study. To ensure consistency, our trial's antihypertensive strategy and titration shall align with those recommended by international guidelines. Blood tests for renal function will be arranged after modifying the prescription of specific anti-hypertensive agents (e.g. ACEis, ARBs, thiazide diuretics and spironolactone).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Small Vessel Cerebrovascular Disease, Stroke
Keywords
Stroke, Small Vessel Disease, Cerebral blood flow, Cognition, Elderly

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
Intensive treatment group: if the mean home SBP preceding clinic follow-up is >130mmHg, BP lowering treatment will be stepped up, and if the mean SBP preceding clinic follow-up is <120mmHg, BP lowering treatment will be stepped down, until the target SBP of 120-129mmHg is achieved, or symptoms of hypotension prevent treatment to be further intensified. Standard treatment group: if the mean home SBP preceding clinic follow-up is >140mmHg, BP lowering treatment will be stepped up, and if the mean SBP preceding clinic follow-up is <130mmHg, BP lowering will be stepped down, until the target SBP 130-140mmg is achieved or symptoms of hypotension prevent treatment being intensified.
Masking
Outcomes Assessor
Masking Description
To avoid bias in outcome assessment, evaluation of the primary and secondary outcome measures will be performed by a group who is independent from the clinical investigators and who will be blinded from all clinical, cognitive and radiological assessments.
Allocation
Randomized
Enrollment
104 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Intensive Treatment Group
Arm Type
Other
Arm Description
SBP target 120-129 mmHg
Arm Title
Standard Treatment Group
Arm Type
Other
Arm Description
SBP target 130-140 mmHg
Intervention Type
Other
Intervention Name(s)
Intensive treatment
Intervention Description
If the mean home SBP preceding clinic follow-up is >130mmHg, BP lowering treatment will be stepped up, and if the mean SBP preceding clinic follow-up is <120mmHg, BP lowering treatment will be stepped down, until the target SBP of 120-129mmHg is achieved, or symptoms of hypotension prevent treatment to be further intensified.
Intervention Type
Other
Intervention Name(s)
Standard treatment
Intervention Description
If the mean home SBP preceding clinic follow-up is >140mmHg, BP lowering treatment will be stepped up, and if the mean SBP preceding clinic follow-up is <130mmHg, BP lowering will be stepped down, until the target SBP 130-140mmg is achieved or symptoms of hypotension prevent treatment being intensified.
Primary Outcome Measure Information:
Title
Cerebral Blood Flow
Description
Change in whole-brain CBF as measured using MRI ASL at end of study (1 year) compared to baseline.
Time Frame
From Baseline to approximate 1 year after recruitment
Secondary Outcome Measure Information:
Title
Grey Matter - Cerebral Blood Flow
Description
Change in Grey Matter CBF as measured using MRI ASL at end of study (1 year) compared to baseline.
Time Frame
From Baseline to approximate 1 year after recruitment
Title
White Matter - Cerebral Blood Flow
Description
Change in white matter CBF as measured using MRI ASL at end of study (1 year) compared to baseline.
Time Frame
From Baseline to approximate 1 year after recruitment
Title
Structural Connectivity
Description
Change in structural connectivity CBF as measured using MRI DTI at end of study (1 year) compared to baseline.
Time Frame
From Baseline to approximate 1 year after recruitment
Title
Cognitive Function - MoCA
Description
Change in MoCA Score at end of study (1 year)
Time Frame
From Baseline to approximate 1 year after recruitment
Title
Cognitive Function - Stroop colour-word test
Description
Change in Stroop colour-word test Score at end of study (1 year)
Time Frame
From Baseline to approximate 1 year after recruitment
Title
Cognitive Function - Digit Symbol Coding test
Description
Change in Digital Symbol Coding test Score at end of study (1 year)
Time Frame
From Baseline to approximate 1 year after recruitment

10. Eligibility

Sex
All
Minimum Age & Unit of Time
50 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Aged ≥50 Chinese ethnicity History of TIA/ischaemic stroke Underlying severe cerebral SVD as evidenced by brain MRI with total SVD score ≥3 Underlying hypertension (defined as either SBP >140mmHg and taking no more than two anti-hypertensive agents, or SBP between 130-140mmHg and on at least one and not more than three anti-hypertensive agents) Able to provide written informed consent Able to perform study cognitive assessments Modified Rankin Scale (mRS) ≤3 Expected life expectancy >2 years Exclusion Criteria: Unable to, or unwilling to consent TIA/ischaemic stroke within three months (to avoid confounding effects of recovery on cognition from recent stroke) Brain MR angiogram showing significant symptomatic or asymptomatic carotid, vertebral or intracranial large artery stenosis ≥50% as measured using the North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria Cortical infarction >2cm in diameter Paroxysmal or permanent atrial fibrillation Known single gene disorder causing cerebral SVD, e.g. cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) Symptomatic postural hypotension Moderate- and severe-stage dementia with Montreal Cognitive Assessment (MOCA)-HK score <10 Moderate and severe depressive symptoms with Patient Health Questionnaire-9 score ≥10 Known secondary hypertension, e.g. hypertension is due to established obstructive sleep apnoea, renal parenchymal disease, renal artery stenosis, primary aldosteronism etc. Unable to complete cognitive assessments mRS >3 Life expectancy of less than 2 years
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Gary KK LAU
Phone
852-22554249
Email
gkklau@hku.hk
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Gary KK LAU
Organizational Affiliation
The University of Hong Kong
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Hong Kong
City
Hong Kong
Country
Hong Kong
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Gary Kui-Kai LAU
Phone
852-22554249
Email
gkklau@hku.hk
First Name & Middle Initial & Last Name & Degree
Gary Kui-Kai LAU
First Name & Middle Initial & Last Name & Degree
Henry Ka-Fung MAK
First Name & Middle Initial & Last Name & Degree
Kay-Cheong TEO

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
30575491
Citation
GBD 2016 Lifetime Risk of Stroke Collaborators; Feigin VL, Nguyen G, Cercy K, Johnson CO, Alam T, Parmar PG, Abajobir AA, Abate KH, Abd-Allah F, Abejie AN, Abyu GY, Ademi Z, Agarwal G, Ahmed MB, Akinyemi RO, Al-Raddadi R, Aminde LN, Amlie-Lefond C, Ansari H, Asayesh H, Asgedom SW, Atey TM, Ayele HT, Banach M, Banerjee A, Barac A, Barker-Collo SL, Barnighausen T, Barregard L, Basu S, Bedi N, Behzadifar M, Bejot Y, Bennett DA, Bensenor IM, Berhe DF, Boneya DJ, Brainin M, Campos-Nonato IR, Caso V, Castaneda-Orjuela CA, Rivas JC, Catala-Lopez F, Christensen H, Criqui MH, Damasceno A, Dandona L, Dandona R, Davletov K, de Courten B, deVeber G, Dokova K, Edessa D, Endres M, Faraon EJA, Farvid MS, Fischer F, Foreman K, Forouzanfar MH, Gall SL, Gebrehiwot TT, Geleijnse JM, Gillum RF, Giroud M, Goulart AC, Gupta R, Gupta R, Hachinski V, Hamadeh RR, Hankey GJ, Hareri HA, Havmoeller R, Hay SI, Hegazy MI, Hibstu DT, James SL, Jeemon P, John D, Jonas JB, Jozwiak J, Kalani R, Kandel A, Kasaeian A, Kengne AP, Khader YS, Khan AR, Khang YH, Khubchandani J, Kim D, Kim YJ, Kivimaki M, Kokubo Y, Kolte D, Kopec JA, Kosen S, Kravchenko M, Krishnamurthi R, Kumar GA, Lafranconi A, Lavados PM, Legesse Y, Li Y, Liang X, Lo WD, Lorkowski S, Lotufo PA, Loy CT, Mackay MT, Abd El Razek HM, Mahdavi M, Majeed A, Malekzadeh R, Malta DC, Mamun AA, Mantovani LG, Martins SCO, Mate KK, Mazidi M, Mehata S, Meier T, Melaku YA, Mendoza W, Mensah GA, Meretoja A, Mezgebe HB, Miazgowski T, Miller TR, Ibrahim NM, Mohammed S, Mokdad AH, Moosazadeh M, Moran AE, Musa KI, Negoi RI, Nguyen M, Nguyen QL, Nguyen TH, Tran TT, Nguyen TT, Anggraini Ningrum DN, Norrving B, Noubiap JJ, O'Donnell MJ, Olagunju AT, Onuma OK, Owolabi MO, Parsaeian M, Patton GC, Piradov M, Pletcher MA, Pourmalek F, Prakash V, Qorbani M, Rahman M, Rahman MA, Rai RK, Ranta A, Rawaf D, Rawaf S, Renzaho AM, Robinson SR, Sahathevan R, Sahebkar A, Salomon JA, Santalucia P, Santos IS, Sartorius B, Schutte AE, Sepanlou SG, Shafieesabet A, Shaikh MA, Shamsizadeh M, Sheth KN, Sisay M, Shin MJ, Shiue I, Silva DAS, Sobngwi E, Soljak M, Sorensen RJD, Sposato LA, Stranges S, Suliankatchi RA, Tabares-Seisdedos R, Tanne D, Nguyen CT, Thakur JS, Thrift AG, Tirschwell DL, Topor-Madry R, Tran BX, Nguyen LT, Truelsen T, Tsilimparis N, Tyrovolas S, Ukwaja KN, Uthman OA, Varakin Y, Vasankari T, Venketasubramanian N, Vlassov VV, Wang W, Werdecker A, Wolfe CDA, Xu G, Yano Y, Yonemoto N, Yu C, Zaidi Z, El Sayed Zaki M, Zhou M, Ziaeian B, Zipkin B, Vos T, Naghavi M, Murray CJL, Roth GA. Global, Regional, and Country-Specific Lifetime Risks of Stroke, 1990 and 2016. N Engl J Med. 2018 Dec 20;379(25):2429-2437. doi: 10.1056/NEJMoa1804492.
Results Reference
background
PubMed Identifier
31097385
Citation
Wardlaw JM, Smith C, Dichgans M. Small vessel disease: mechanisms and clinical implications. Lancet Neurol. 2019 Jul;18(7):684-696. doi: 10.1016/S1474-4422(19)30079-1. Epub 2019 May 13.
Results Reference
background
PubMed Identifier
29792871
Citation
Bos D, Wolters FJ, Darweesh SKL, Vernooij MW, de Wolf F, Ikram MA, Hofman A. Cerebral small vessel disease and the risk of dementia: A systematic review and meta-analysis of population-based evidence. Alzheimers Dement. 2018 Nov;14(11):1482-1492. doi: 10.1016/j.jalz.2018.04.007. Epub 2018 May 21.
Results Reference
background
PubMed Identifier
29748422
Citation
Lau KK, Lovelock CE, Li L, Simoni M, Gutnikov S, Kuker W, Mak HKF, Rothwell PM. Antiplatelet Treatment After Transient Ischemic Attack and Ischemic Stroke in Patients With Cerebral Microbleeds in 2 Large Cohorts and an Updated Systematic Review. Stroke. 2018 Jun;49(6):1434-1442. doi: 10.1161/STROKEAHA.117.020104. Epub 2018 May 10.
Results Reference
background
PubMed Identifier
28515266
Citation
Lau KK, Li L, Schulz U, Simoni M, Chan KH, Ho SL, Cheung RTF, Kuker W, Mak HKF, Rothwell PM. Total small vessel disease score and risk of recurrent stroke: Validation in 2 large cohorts. Neurology. 2017 Jun 13;88(24):2260-2267. doi: 10.1212/WNL.0000000000004042. Epub 2017 May 17.
Results Reference
background
PubMed Identifier
17210627
Citation
Khan U, Porteous L, Hassan A, Markus HS. Risk factor profile of cerebral small vessel disease and its subtypes. J Neurol Neurosurg Psychiatry. 2007 Jul;78(7):702-6. doi: 10.1136/jnnp.2006.103549. Epub 2007 Jan 8.
Results Reference
background
PubMed Identifier
24788967
Citation
Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD, Fang MC, Fisher M, Furie KL, Heck DV, Johnston SC, Kasner SE, Kittner SJ, Mitchell PH, Rich MW, Richardson D, Schwamm LH, Wilson JA; American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Peripheral Vascular Disease. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014 Jul;45(7):2160-236. doi: 10.1161/STR.0000000000000024. Epub 2014 May 1. Erratum In: Stroke. 2015 Feb;46(2):e54.
Results Reference
background
PubMed Identifier
23726159
Citation
SPS3 Study Group; Benavente OR, Coffey CS, Conwit R, Hart RG, McClure LA, Pearce LA, Pergola PE, Szychowski JM. Blood-pressure targets in patients with recent lacunar stroke: the SPS3 randomised trial. Lancet. 2013 Aug 10;382(9891):507-15. doi: 10.1016/S0140-6736(13)60852-1. Epub 2013 May 29. Erratum In: Lancet. 2013 Aug 10;382(9891):506. Coffey, C S [aded].
Results Reference
background
PubMed Identifier
29739911
Citation
van Middelaar T, Argillander TE, Schreuder FHBM, Deinum J, Richard E, Klijn CJM. Effect of Antihypertensive Medication on Cerebral Small Vessel Disease: A Systematic Review and Meta-Analysis. Stroke. 2018 Jun;49(6):1531-1533. doi: 10.1161/STROKEAHA.118.021160. Epub 2018 May 8.
Results Reference
background
PubMed Identifier
24255596
Citation
Denker MG, Cohen DL. What is an appropriate blood pressure goal for the elderly: review of recent studies and practical recommendations. Clin Interv Aging. 2013;8:1505-17. doi: 10.2147/CIA.S33087. Epub 2013 Nov 14.
Results Reference
background
PubMed Identifier
15860749
Citation
Birns J, Markus H, Kalra L. Blood pressure reduction for vascular risk: is there a price to be paid? Stroke. 2005 Jun;36(6):1308-13. doi: 10.1161/01.STR.0000165901.38039.5f. Epub 2005 Apr 28.
Results Reference
background
PubMed Identifier
29507944
Citation
Croall ID, Tozer DJ, Moynihan B, Khan U, O'Brien JT, Morris RG, Cambridge VC, Barrick TR, Blamire AM, Ford GA, Markus HS; PRESERVE Study Team. Effect of Standard vs Intensive Blood Pressure Control on Cerebral Blood Flow in Small Vessel Disease: The PRESERVE Randomized Clinical Trial. JAMA Neurol. 2018 Jun 1;75(6):720-727. doi: 10.1001/jamaneurol.2017.5153.
Results Reference
background
PubMed Identifier
3496763
Citation
Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA. MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging. AJR Am J Roentgenol. 1987 Aug;149(2):351-6. doi: 10.2214/ajr.149.2.351.
Results Reference
background
PubMed Identifier
25165388
Citation
Staals J, Makin SD, Doubal FN, Dennis MS, Wardlaw JM. Stroke subtype, vascular risk factors, and total MRI brain small-vessel disease burden. Neurology. 2014 Sep 30;83(14):1228-34. doi: 10.1212/WNL.0000000000000837. Epub 2014 Aug 27.
Results Reference
background
PubMed Identifier
28495831
Citation
Lau KK, Li L, Lovelock CE, Zamboni G, Chan TT, Chiang MF, Lo KT, Kuker W, Mak HK, Rothwell PM. Clinical Correlates, Ethnic Differences, and Prognostic Implications of Perivascular Spaces in Transient Ischemic Attack and Ischemic Stroke. Stroke. 2017 Jun;48(6):1470-1477. doi: 10.1161/STROKEAHA.117.016694. Epub 2017 May 11.
Results Reference
background
PubMed Identifier
30354991
Citation
Lau KK, Li L, Simoni M, Mehta Z, Kuker W, Rothwell PM; Oxford Vascular Study. Long-Term Premorbid Blood Pressure and Cerebral Small Vessel Disease Burden on Imaging in Transient Ischemic Attack and Ischemic Stroke. Stroke. 2018 Sep;49(9):2053-2060. doi: 10.1161/STROKEAHA.118.021578.
Results Reference
background
PubMed Identifier
29523652
Citation
Liu B, Lau KK, Li L, Lovelock C, Liu M, Kuker W, Rothwell PM. Age-Specific Associations of Renal Impairment With Magnetic Resonance Imaging Markers of Cerebral Small Vessel Disease in Transient Ischemic Attack and Stroke. Stroke. 2018 Apr;49(4):899-904. doi: 10.1161/STROKEAHA.117.019650. Epub 2018 Mar 9.
Results Reference
background
PubMed Identifier
29966494
Citation
Lau KK, Pego P, Mazzucco S, Li L, Howard DP, Kuker W, Rothwell PM. Age and sex-specific associations of carotid pulsatility with small vessel disease burden in transient ischemic attack and ischemic stroke. Int J Stroke. 2018 Oct;13(8):832-839. doi: 10.1177/1747493018784448. Epub 2018 Jul 3.
Results Reference
background
PubMed Identifier
29748646
Citation
Xu X, Lau KK, Wong YK, Mak HKF, Hui ES. The effect of the total small vessel disease burden on the structural brain network. Sci Rep. 2018 May 10;8(1):7442. doi: 10.1038/s41598-018-25917-4.
Results Reference
background
PubMed Identifier
1852179
Citation
North American Symptomatic Carotid Endarterectomy Trial Collaborators; Barnett HJM, Taylor DW, Haynes RB, Sackett DL, Peerless SJ, Ferguson GG, Fox AJ, Rankin RN, Hachinski VC, Wiebers DO, Eliasziw M. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med. 1991 Aug 15;325(7):445-53. doi: 10.1056/NEJM199108153250701.
Results Reference
background
PubMed Identifier
19672065
Citation
Wong A, Xiong YY, Kwan PW, Chan AY, Lam WW, Wang K, Chu WC, Nyenhuis DL, Nasreddine Z, Wong LK, Mok VC. The validity, reliability and clinical utility of the Hong Kong Montreal Cognitive Assessment (HK-MoCA) in patients with cerebral small vessel disease. Dement Geriatr Cogn Disord. 2009;28(1):81-7. doi: 10.1159/000232589. Epub 2009 Aug 11.
Results Reference
background
PubMed Identifier
21193179
Citation
Yu X, Tam WW, Wong PT, Lam TH, Stewart SM. The Patient Health Questionnaire-9 for measuring depressive symptoms among the general population in Hong Kong. Compr Psychiatry. 2012 Jan;53(1):95-102. doi: 10.1016/j.comppsych.2010.11.002. Epub 2010 Dec 28.
Results Reference
background
PubMed Identifier
10923056
Citation
Lee TM, Chan CC. Stroop interference in Chinese and English. J Clin Exp Neuropsychol. 2000 Aug;22(4):465-71. doi: 10.1076/1380-3395(200008)22:4;1-0;FT465.
Results Reference
background
PubMed Identifier
30159766
Citation
Lam CLM, Liu HL, Huang CM, Wai YY, Lee SH, Yiend J, Lin C, Lee TMC. The neural correlates of perceived energy levels in older adults with late-life depression. Brain Imaging Behav. 2019 Oct;13(5):1397-1405. doi: 10.1007/s11682-018-9940-y.
Results Reference
background
PubMed Identifier
30165516
Citation
Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I; ESC Scientific Document Group. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018 Sep 1;39(33):3021-3104. doi: 10.1093/eurheartj/ehy339. No abstract available. Erratum In: Eur Heart J. 2019 Feb 1;40(5):475.
Results Reference
background

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Intensive Blood Pressure Control in Ischaemic Stroke Patients With Severe Cerebral Small Vessel Disease

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