Stroke, Vol 24, 1844-1849, Copyright © 1993 by American Heart Association
K Irie, T Yamaguchi, K Minematsu and T Omae
BACKGROUND AND PURPOSE: The relation of poststroke blood pressure to stroke
recurrence remains undetermined, and the optimal control of blood pressure
has not been established. We performed the present study to resolve these
issues. METHODS: We analyzed 368 stroke patients with a history of
hypertension (mean age, 62 years) who were admitted within 3 months after
stroke onset and observed for 6 months or more. We determined stroke
recurrence rate in relation to baseline (or initial) blood pressure, mean
values of poststroke blood pressure, stroke subtypes, age, antihypertensive
treatment, and other clinical features. RESULTS: The recurrence rate had a
J-curve relation to poststroke diastolic blood pressure but not to
poststroke systolic blood pressure and baseline diastolic and systolic
blood pressures. The stroke recurrence rate was 3.8% per patient-year in 94
patients who had a poststroke diastolic blood pressure of 80 to 84 mm Hg,
significantly lower than the rates of 9.2% per patient-year (P < .05)
and 11.4% per patient-year (P < .01) in those with a lower and higher
poststroke diastolic blood pressure, respectively. The range of poststroke
diastolic blood pressure accompanying the lowest stroke recurrence rate was
higher in patients with atherothrombotic (85 to 89 mm Hg) than in those
with lacunar infarction (80 to 84 mm Hg). Neither antihypertensive therapy
nor patients' age affected this phenomenon. CONCLUSIONS: The present study
suggests that lower blood pressure does not always result in favorable
effects on stroke recurrence. The effects of poststroke blood pressure and
antihypertensive therapy on stroke recurrence may be complicated by the
J-curve phenomenon.
ARTICLES
The J-curve phenomenon in stroke recurrence
Cerebrovascular Division, National Cardiovascular Center, Osaka, Japan.
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