Systolic Blood Pressure Control and Mortality After Stroke in Hypertensive Patients
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 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 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/ct/show/NCT00338260?order=1. Unique identifier: NCT00338260.
- Received March 27, 2015.
- Revision received April 30, 2015.
- Accepted May 18, 2015.
- © 2015 American Heart Association, Inc.