Amytis Towfighi1, Daniela Markovic, Bruce Ovbiagele. 1. From the Department of Neurology, University of Southern California, Los Angeles, CA (A.T.); Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, CA (A.T.); Department of Biomathematics, University of California, Los Angeles (D.M.); and Department of Neurosciences, Medical University of South Carolina, Charleston, SC (B.O.).
Abstract
BACKGROUND AND PURPOSE: Blood pressure (BP) reduction lowers vascular risk after stroke; however, little is known about the relationship between consistency of BP control and risk of subsequent vascular events. METHODS: In this post hoc analysis of the Vitamin Intervention for Stroke Prevention trial (n=3680), individuals with recent (<120 days) stroke, followed up for 2 years, were divided according to proportion of visits in which BP was controlled (<140/90 mm Hg): <25%, 25% to 49%, 50% to 74%, and ≥75%. Multivariable models adjusting for demographic and clinical variables determined the association between consistency of BP control versus primary (stroke) and secondary (stroke, myocardial infarction, or vascular death) outcomes. RESULTS: Only 30% of participants had BP controlled ≥75% of the time. Consistency of BP control affected outcomes in individuals with baseline systolic BP>132 mm Hg. Among individuals with baseline systolic BP>75th percentile (>153 mm Hg), risks of primary and secondary outcomes were lower in those with BP controlled ≥75% versus <25% of visits (adjusted hazard ratio, 0.46; 95% confidence interval, 0.26-0.84 and adjusted hazard ratio, 0.51; 95% confidence interval, 0.32-0.82). Individuals with mean follow-up BP<140/90 mm Hg had lower risk of primary and secondary outcomes than those with BP≥140/90 mm Hg (adjusted hazard ratio, 0.76; 95% confidence interval, 0.59-0.98 and adjusted hazard ratio, 0.76; 95% confidence interval, 0.62-0.92). CONCLUSIONS: In this rigorous clinical trial, fewer than one third of patients with stroke had BP controlled ≥75% of the time for 2 years. Furthermore, consistency of BP control among those with elevated baseline systolic BP was linked to reduction in risk of recurrent stroke and stroke, myocardial infarction, and vascular death.
BACKGROUND AND PURPOSE: Blood pressure (BP) reduction lowers vascular risk after stroke; however, little is known about the relationship between consistency of BP control and risk of subsequent vascular events. METHODS: In this post hoc analysis of the Vitamin Intervention for Stroke Prevention trial (n=3680), individuals with recent (<120 days) stroke, followed up for 2 years, were divided according to proportion of visits in which BP was controlled (<140/90 mm Hg): <25%, 25% to 49%, 50% to 74%, and ≥75%. Multivariable models adjusting for demographic and clinical variables determined the association between consistency of BP control versus primary (stroke) and secondary (stroke, myocardial infarction, or vascular death) outcomes. RESULTS: Only 30% of participants had BP controlled ≥75% of the time. Consistency of BP control affected outcomes in individuals with baseline systolic BP>132 mm Hg. Among individuals with baseline systolic BP>75th percentile (>153 mm Hg), risks of primary and secondary outcomes were lower in those with BP controlled ≥75% versus <25% of visits (adjusted hazard ratio, 0.46; 95% confidence interval, 0.26-0.84 and adjusted hazard ratio, 0.51; 95% confidence interval, 0.32-0.82). Individuals with mean follow-up BP<140/90 mm Hg had lower risk of primary and secondary outcomes than those with BP≥140/90 mm Hg (adjusted hazard ratio, 0.76; 95% confidence interval, 0.59-0.98 and adjusted hazard ratio, 0.76; 95% confidence interval, 0.62-0.92). CONCLUSIONS: In this rigorous clinical trial, fewer than one third of patients with stroke had BP controlled ≥75% of the time for 2 years. Furthermore, consistency of BP control among those with elevated baseline systolic BP was linked to reduction in risk of recurrent stroke and stroke, myocardial infarction, and vascular death.
Entities:
Keywords:
blood pressure; hypertension; mortality; prevention and control; stroke
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