Changwei Li1,2,3, Yonghong Zhang1,4, Tan Xu1,4, Hao Peng1,4, Dali Wang5, Tian Xu1,4,6, Yingxian Sun7, Xiaoqing Bu1, Chung-Shiuan Chen2, Aili Wang1,4, Jinchao Wang8, Qunwei Li9, Zhong Ju10, Deqin Geng11, Jintao Zhang12, Jing Chen2,5,13, Jiang He1,2,13,14. 1. Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, China. 2. Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA. 3. Department of Epidemiology & Biostatistics, University of Georgia College of Public Health, GA, USA. 4. Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, Suzhou, China. 5. Department of Neurology, Affiliated Hospital of North China University of Science and Technology, Hebei, China. 6. Department of Neurology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China. 7. Department of Cardiology, The First Affiliated Hospital of China Medical University, Liaoning, China. 8. Department of Neurology, Yutian County Hospital, Hebei, China. 9. Department of Epidemiology, School of Public Health, Taishan Medical College, Shandong, China. 10. Department of Neurology, Kerqin District First People's Hospital of Tongliao City, Inner Mongolia, China. 11. Department of Neurology, Affiliated Hospital of Xuzhou Medical College, Jiangsu, China. 12. Department of Neurology, The 88th Hospital of PLA, Shandong, China. 13. Tulane University Translational Science Institute, Tulane University, New Orleans, Louisiana, USA. 14. Department of Medicine, School of Medicine, Tulane University, New Orleans, Louisiana, USA.
Abstract
BACKGROUND: Optimal blood pressure (BP) levels during acute ischemic stroke have not been established. We studied associations between systolic BP trajectories during acute phase and subsequent clinical outcomes among patients with ischemic stroke. METHODS: A total of 4,036 patients with acute ischemic stroke and elevated BP from the China Antihypertensive Trial in Acute Ischemic Stroke trial were included in this analysis. Three BPs were measured every 2 hours in day 1, every 4 hours during days 2 and 3, and every 8 hours thereafter until hospital discharge or death. Clinical outcomes were assessed at 3, 12, and 24 months. Latent variable mixture modeling was used to identify subgroups that share a similar underlying trajectory of systolic BP during the first 7 days after stroke onset. Logistic regression and Cox proportional hazards models were used to examine the associations between systolic BP trajectories and clinical outcomes during follow-up. RESULTS: We identified 5 systolic BP trajectories of high, high-to-moderate-low, moderate-high, moderate-low, and low. Compared to participants in high trajectory, multiple-adjusted odds ratios (95% confidence interval) of all-cause mortality at 3 months for individuals in high-to-moderate-low, moderate-high, moderate-low, and low were 0.34 (0.15-0.77), 0.58 (0.32-1.04), 0.29 (0.15-0.56), and 0.56 (0.26-1.19), respectively. Likewise, the corresponding hazard ratios for all-cause mortality in 24 months were 0.66 (0.44-1.00), 0.74 (0.53-1.05), 0.45 (0.32-0.66), and 0.61 (0.40-0.93), respectively. Similar associations were observed for recurrent stroke and cardiovascular disease, and in both the intervention and control groups. CONCLUSIONS: Patients with moderate-low systolic BP during acute ischemic stroke had a lower risk of adverse clinical outcomes.
BACKGROUND: Optimal blood pressure (BP) levels during acute ischemic stroke have not been established. We studied associations between systolic BP trajectories during acute phase and subsequent clinical outcomes among patients with ischemic stroke. METHODS: A total of 4,036 patients with acute ischemic stroke and elevated BP from the China Antihypertensive Trial in Acute Ischemic Stroke trial were included in this analysis. Three BPs were measured every 2 hours in day 1, every 4 hours during days 2 and 3, and every 8 hours thereafter until hospital discharge or death. Clinical outcomes were assessed at 3, 12, and 24 months. Latent variable mixture modeling was used to identify subgroups that share a similar underlying trajectory of systolic BP during the first 7 days after stroke onset. Logistic regression and Cox proportional hazards models were used to examine the associations between systolic BP trajectories and clinical outcomes during follow-up. RESULTS: We identified 5 systolic BP trajectories of high, high-to-moderate-low, moderate-high, moderate-low, and low. Compared to participants in high trajectory, multiple-adjusted odds ratios (95% confidence interval) of all-cause mortality at 3 months for individuals in high-to-moderate-low, moderate-high, moderate-low, and low were 0.34 (0.15-0.77), 0.58 (0.32-1.04), 0.29 (0.15-0.56), and 0.56 (0.26-1.19), respectively. Likewise, the corresponding hazard ratios for all-cause mortality in 24 months were 0.66 (0.44-1.00), 0.74 (0.53-1.05), 0.45 (0.32-0.66), and 0.61 (0.40-0.93), respectively. Similar associations were observed for recurrent stroke and cardiovascular disease, and in both the intervention and control groups. CONCLUSIONS: Patients with moderate-low systolic BP during acute ischemic stroke had a lower risk of adverse clinical outcomes.
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