Control of Hypertension and Risk of Stroke Recurrence

Abstract

Background and Purpose-We investigated whether low blood pressure increases the risk of stroke recurrence. Methods-A cohort of 662 patients, obtaining care at the 8 acute care hospitals serving the Lehigh Valley in Pennsylvania, was enrolled within 1 month of an initial stroke and was followed twice annually for up to 4 years. Cox proportional hazard models were developed to examine the relationship between risk of recurrent stroke and blood pressure, controlling for other significant risk factors. Our analyses investigated both lowest follow-up and average follow-up blood pressures as predictors of stroke recurrence. Results-There were 52 recurrent strokes among the 535 patients (mean age, 71 years; 51% men) with follow-up blood pressure. The risk ratio for stroke recurrence for diastolic blood pressure Ն80 mm Hg compared with Ͻ80 mm Hg was 2.4 (95% CI, 1.38 to 4.27) and for systolic blood pressure Ն140 mm Hg compared with Ͻ140 mm Hg was also 2.4 (95% CI, 1.39 to 4.15). For isolated systolic blood pressure (Ͼ140/Ͻ90 mm Hg), the risk ratio was 2.2 (95% CI, 1.23 to 3.79) relative to Ͻ140/Ͻ90 mm Hg. Using the Cox model, we also showed that patients who had at least 1 measured diastolic blood pressure Ͻ80 mm Hg during follow-up had a reduced risk of stroke recurrence compared with those with diastolic blood pressures 80 to 90 mm Hg (0.4 versus 1.0; 95% CI, 0.21 to 0.88) even after controlling for the possible confounding factors of hypertension and atrial fibrillation on ECG. Myocardial infarction on ECG, history of transient ischemic attack, and diabetes mellitus were not significant predictors of increased risk of recurrent stroke. Conclusions-Our results imply that "lower is better" for blood pressure control as a goal in reducing stroke recurrence risk.

Relationship Between Blood Pressure and Stroke Recurrence in Patients With Intracranial Arterial Stenosis

“…Although the high risk of stroke with increased SBP was driven largely by the SBP Ն160 mm Hg group, no evidence existed that maintaining SBP in a moderately hypertensive range (ie, 140 to 159 mm Hg), as is commonly done in clinical practice, was protective against stroke. Previous studies have demonstrated that patients with heterogeneous and often undefined causes of stroke have a lower risk of stroke recurrence with lowering of blood pressure, 3 but this study is the first to demonstrate this finding among patients with symptomatic intracranial stenosis.…”

Recurrence after a First- ever Ischemic Stroke Development of a Clinical Prediction Rule

“…[9] Arterial hypertension is a recognized risk factor for cardiovascular and cerebrovascular disease [28]related with atherosclerosis [29][30][31][32]. It is known that optimal control of blood pressure reduces the risk [33]as well as the recurrence of ischemic stroke [34,35].…”

Factors associated with development of stroke long‐term after myocardial infarction: experiences from the LoWASA trial

“…This was also an expected finding. Hypertension is one of the major risk indicators for stroke [7][8][9][10].…”