Peter M Okin1, Sverre E Kjeldsen2, Richard B Devereux2. 1. From the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY (P.M.O., R.B.D.); Department of Cardiology, University of Oslo, Ullevål Hospital, Oslo, Norway (S.E.K.); and Department of Medicine, University of Michigan Medical Center, Ann Arbor (S.E.K.). pokin@med.cornell.edu. 2. From the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY (P.M.O., R.B.D.); Department of Cardiology, University of Oslo, Ullevål Hospital, Oslo, Norway (S.E.K.); and Department of Medicine, University of Michigan Medical Center, Ann Arbor (S.E.K.).
Abstract
BACKGROUND AND PURPOSE:Hypertensive patients with electrocardiographic left ventricular hypertrophy are at increased risk of all-cause and cardiovascular death. Lowering blood pressure (BP) after stroke reduces the risk of recurrent stroke, but recent data suggest that lower systolic BP (SBP) measured 5 years after stroke is associated with increased mortality. Whether lower SBP is associated with increased short-term mortality after stroke in hypertensive patients is unclear. METHODS: All-cause and cardiovascular mortality were examined in relation to average on-treatment SBP after stroke in 541 hypertensive patients with electrocardiographic left ventricular hypertrophy randomly assigned tolosartan- or atenolol-based treatment who had new strokes during follow-up. Patients with on-treatmentSBP<144 mm Hg (lowest tertile) and SBP>157 (highest tertile) were compared with patients with average SBP between 144 and 157. RESULTS: During 2.02±1.65 years mean follow-up after incident stroke, 170 patients (31.4%) died, 135 (25.0%) from cardiovascular causes. In multivariate Cox analyses, adjusting for significant univariate predictors of mortality, compared with average SBP between 144 and 157, an average SBP<144 was a significant predictor of all-cause (hazard ratio, 1.81; 95% confidence interval, 1.20-2.73) and cardiovascular mortality (hazard ratio, 1.60; 95% confidence interval, 1.02-2.54), whereas patients who had an average SBP>157 had no significant increased risk of death. CONCLUSIONS: Lower achieved SBP (<144 mm Hg) is associated with a significantly increased risk of cardiovascular and all-cause mortality after initial stroke in hypertensive patients during short-term follow-up. Further study is required to determine ideal SBP goals after stroke. CLINICAL TRIAL REGISTRATION: URL: http://clinicaltrials.gov/. Unique identifier: NCT00338260.
RCT Entities:
BACKGROUND AND PURPOSE:Hypertensivepatients with electrocardiographic left ventricular hypertrophy are at increased risk of all-cause and cardiovascular death. Lowering blood pressure (BP) after stroke reduces the risk of recurrent stroke, but recent data suggest that lower systolic BP (SBP) measured 5 years after stroke is associated with increased mortality. Whether lower SBP is associated with increased short-term mortality after stroke in hypertensivepatients is unclear. METHODS: All-cause and cardiovascular mortality were examined in relation to average on-treatment SBP after stroke in 541 hypertensivepatients with electrocardiographic left ventricular hypertrophy randomly assigned to losartan- or atenolol-based treatment who had new strokes during follow-up. Patients with on-treatment SBP<144 mm Hg (lowest tertile) and SBP>157 (highest tertile) were compared with patients with average SBP between 144 and 157. RESULTS: During 2.02±1.65 years mean follow-up after incident stroke, 170 patients (31.4%) died, 135 (25.0%) from cardiovascular causes. In multivariate Cox analyses, adjusting for significant univariate predictors of mortality, compared with average SBP between 144 and 157, an average SBP<144 was a significant predictor of all-cause (hazard ratio, 1.81; 95% confidence interval, 1.20-2.73) and cardiovascular mortality (hazard ratio, 1.60; 95% confidence interval, 1.02-2.54), whereas patients who had an average SBP>157 had no significant increased risk of death. CONCLUSIONS: Lower achieved SBP (<144 mm Hg) is associated with a significantly increased risk of cardiovascular and all-cause mortality after initial stroke in hypertensivepatients during short-term follow-up. Further study is required to determine ideal SBP goals after stroke. CLINICAL TRIAL REGISTRATION: URL: http://clinicaltrials.gov/. Unique identifier: NCT00338260.
Authors: Hugo J Aparicio; Laura M Tarko; David Gagnon; Lauren Costa; Ashley Galloway; Serkalem Demissie; Luc Djousse; Sudha Seshadri; Kelly Cho; Peter W F Wilson Journal: Stroke Date: 2021-11-03 Impact factor: 7.914