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Post-stroke diastolic blood pressure and risk of recurrent vascular events
1Department of Neurology, Seonam University Myongji Hospital, Goyang, South Korea.
Insights
Low diastolic blood pressure (DBP) after stroke increases the risk of major vascular events and stroke, especially when pulse pressure is high. This highlights the importance of monitoring DBP alongside systolic blood pressure in post-stroke patients.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Clinical Research
Background:
- Current guidelines focus on systolic blood pressure (SBP) targets for vascular risk reduction.
- Limited data exists on diastolic blood pressure (DBP) levels and vascular outcomes post-stroke.
Purpose of the Study:
- To investigate the association between diastolic blood pressure (DBP) levels and major vascular events (MVEs) or ischemic stroke in patients with recent non-cardioembolic stroke.
Main Methods:
- Analysis of a multicenter trial dataset of 3680 patients with recent non-cardioembolic stroke, followed for 2 years.
- Patients categorized by mean DBP: low-normal (<70 mmHg), normal (70 to <80 mmHg), high-normal (80-89 mmHg), and high (≥90 mmHg).
- Pulse pressure (PP) categorized as <60, 60 to <70, and ≥70 mmHg.
Main Results:
- Major vascular events (MVEs) occurred in 20.7% of the low-normal DBP group versus 15.1% in the normal DBP group.
- Stroke occurred in 9.9% of the low-normal DBP group versus 6.8% in the normal DBP group.
- Elevated PP (≥70 mmHg) was associated with increased MVEs and stroke risk in specific SBP ranges, particularly with lower mean DBP.
Conclusions:
- Low-normal diastolic blood pressure (DBP) levels (<70 mmHg), especially with elevated pulse pressure (>60 mmHg), are linked to a higher risk of major vascular events and stroke in patients post-non-cardioembolic stroke.
Background And Purpose:
Recent clinical trials and expert consensus guidelines have typically focused on the issue of systolic blood pressure (SBP) targets for reducing vascular risk. However, little is known about the relationship of the diastolic BP (DBP) level with vascular outcomes after a stroke.
Methods:
A multicenter trial dataset involving 3680 recent (<4 months) non-cardioembolic stroke patients followed for 2 years was analyzed. Subjects were categorized per mean DBP level (mmHg) during follow-up: low-normal (<70), normal (70 to <80), high-normal (80-89) and high (≥90). Pulse pressure (PP) was prespecified by three categories of <60, 60 to <70, and ≥70 mmHg. Independent associations of mean DBP level with major vascular events (MVEs) and ischaemic stroke were assessed.
Results:
Major vascular events occurred in 20.7% of the low-normal, 15.1% of the normal, 16.9% of the high-normal and 19.2% of the high DBP groups, whilst stroke occurred in 9.9%, 6.8%, 8.5% and 10.8%, respectively. Compared with the normal DBP group, risk of MVEs was higher in the low-normal DBP group (adjusted hazard ratio 1.33; 95% confidence interval 1.04-1.71). Amongst those with SBP 120 to <140 mmHg, risk of MVEs (1.89; 1.13-3.15) and stroke (2.87; 1.48-5.53) was higher in subjects with PP ≥70 (mean DBP 62.4 ± 3.8) than those with the lowest PP (mean DBP 78.0 ± 5.9) whilst, amongst those with SBP <120 mmHg, PP 60 to <70 (mean DBP 52.7 ± 2.5) was associated with increased risk of stroke (5.85; 1.25-27.5).
Conclusion:
Diastolic BP levels in the low-normal range, particularly accompanied by an increased PP of >60, confer increased risk of MVEs and stroke amongst patients after recent non-cardioembolic stroke.
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