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Systolic Blood Pressure Control and Mortality After Stroke in Hypertensive Patients

Peter M Okin1, Sverre E Kjeldsen2, Richard B Devereux2

  • 1From 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.

Stroke
|June 20, 2015
PubMed

Insights

Lowering systolic blood pressure (SBP) too much after a stroke in hypertensive patients with left ventricular hypertrophy increases mortality risk. Achieving SBP below 144 mm Hg is linked to higher risks of death from all causes and cardiovascular events.

Area of Science:

  • Cardiology
  • Neurology
  • Clinical Trials

Background:

  • Hypertensive patients with left ventricular hypertrophy face elevated risks of death.
  • Lowering blood pressure post-stroke aids recurrent stroke prevention.
  • Emerging data link lower post-stroke systolic blood pressure (SBP) to increased long-term mortality.

Purpose of the Study:

  • To investigate the association between achieved SBP and short-term mortality after stroke in hypertensive patients with left ventricular hypertrophy.
  • To clarify the optimal SBP targets for hypertensive patients post-stroke.

Main Methods:

  • Examined all-cause and cardiovascular mortality in 541 hypertensive patients with left ventricular hypertrophy post-stroke.
  • Patients were randomized to losartan- or atenolol-based treatment.
  • Compared mortality rates based on average on-treatment SBP tertiles (<144 mm Hg, 144-157 mm Hg, >157 mm Hg).

Main Results:

  • During a mean follow-up of 2.02 years, 31.4% of patients died (25.0% from cardiovascular causes).
  • An average SBP <144 mm Hg was a significant predictor of increased all-cause (HR, 1.81) and cardiovascular mortality (HR, 1.60) compared to SBP 144-157 mm Hg.
  • An average SBP >157 mm Hg did not show a significant increase in mortality risk.

Conclusions:

  • Lower achieved SBP (<144 mm Hg) is significantly associated with increased cardiovascular and all-cause mortality in hypertensive patients shortly after an initial stroke.
  • Further research is needed to establish ideal SBP goals post-stroke.
Abstract

Keywords:
blood pressureelectrocardiographyhypertensionhypertrophystroke

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