Effect of the Ca Antagonist Nilvadipine on Stroke Occurrence or Recurrence and Extension of Asymptomatic Cerebral Infarction in Hypertensive Patients with or without History of Stroke (PICA Study)

BACKGROUND

We examined the effect of a Ca antagonist (nilvadipine) on the occurrence or recurrence of symptomatic stroke in hypertensive patients with MRI-defined asymptomatic cerebral infarction (ACI), periventricular hyperintensity (PVH), and deep and subcortical white matter hyperintensity (DSWMH), with or without a history of stroke, and evaluated the effect of long-term treatment on the lesions.

METHODS

Patients with hypertension and incidental ACI were divided into those with (group B, 235 patients) or without (group A, 181 patients) a history of symptomatic stroke, and were given nilvadipine 4-8 mg/day for 3 years. Primary evaluation points were occurrence of symptomatic ischemic stroke and development or extension of asymptomatic ischemic lesions.

RESULTS

Male sex, hyperuricemia, diabetes, maximum diameter of infarction and PVH severity were stronger risk factors for group B. Numbers of cerebral infarctions were 31 +/- 28 (group A) and 42 +/- 32 (group B) at enrollment (p < 0.001). Infarctions were larger and located more frequently on the internal capsule, putamen, thalamus and brainstem in group B. The severity of PVH and DSWMH paralleled the number of cerebral infarctions in both groups.

CONCLUSION

The study design and status of asymptomatic ischemic brain lesions in hypertensive subjects at enrollment are presented.

Atherosclerotic changes in intracranial and extracranial large arteries in apparently healthy persons with asymptomatic lacunar infarction

To clarify the relationship between large-vessel disease and asymptomatic cerebral infarction (ACI), we evaluated atherosclerotic changes in intracranial and extracranial arteries in adults with and without ACI. Subjects were 142 apparently healthy persons with ACI on magnetic resonance imaging (MRI) (ACI group) and 605 age matched persons without cerebral infarction on MRI. The 605 age-matched persons were divided into 380 persons with cerebrovascular risk factors (RF group) and 225 persons without cerebrovascular risk factors (NC group). Intracranial arteries (internal carotid artery, main trunks of the middle cerebral artery, and basilar artery) were examined by magnetic resonance angiography (MRA), and extracranial carotid arteries were investigated using B-mode ultrasonography. Stenosis of 25% to 49% in intracranial arteries detected on MRA was significantly more frequent in the ACI group (16%) than in the RF group (8%) or NC group (4%) (P < .05 and P < .001, respectively). On B mode ultrasonography, the prevalences of <25% stenosis (29%) and 25% to 49% stenosis (7%) in extracranial carotid arteries in the ACI group were significantly greater than those in the NC group (16% and 2% respectively, P < .05), whereas >/=50% stenosis was significantly more frequent in the ACI group (6%) than in the RF group (2%; P < .05). There was no statistically significant difference in prevalence of stenosis in intracranial and extracranial large arteries between persons with ipsilateral stenosis and infarction and persons with contralateral stenosis and infarction. We conclude that potential major cerebral vessel disease frequently coexists in persons with asymptomatic lacunar infarction.