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Relation Between Blood Pressure and Clinical Outcome in Hypertensive Subjects With Previous Stroke
Chan Joo Lee1, Jinseub Hwang2, Jaewon Oh3
1Department of Health Promotion, Severance Hospital, Seoul, Korea.
Insights
Lowering blood pressure (BP) to below 130/80 mm Hg in patients with hypertension and prior stroke significantly reduces cardiovascular mortality and stroke risk. Achieving this target BP is associated with improved patient outcomes.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Hypertension and previous stroke are significant risk factors for cardiovascular events.
- Optimal blood pressure (BP) targets for secondary prevention in these patients remain under investigation.
Purpose of the Study:
- To investigate the association between a mean BP of <130/80 mm Hg and cardiovascular outcomes in treated hypertensive patients with a history of stroke.
Main Methods:
- A cohort of 2320 hypertensive patients with previous stroke was analyzed.
- Patients were grouped by mean systolic BP (<130, 130-<140, ≥140 mm Hg) and diastolic BP (<80, 80-<90, ≥90 mm Hg).
- All-cause and cardiovascular mortality were compared over an 11-year follow-up period.
Main Results:
- A systolic BP of 130 to <140 mm Hg was associated with significantly lower risks of all-cause death, cardiovascular mortality, and fatal ischemic stroke compared to BP ≥140 mm Hg.
- A diastolic BP of 80 to <90 mm Hg was linked to significantly lower risks of all-cause death and cardiovascular mortality compared to BP ≥90 mm Hg.
- Systolic BP <130 mm Hg and diastolic BP <80 mm Hg were associated with reduced risks of nonfatal hemorrhagic stroke and further reductions in mortality.
Conclusions:
- A mean blood pressure below 130/80 mm Hg is associated with improved cardiovascular outcomes in hypertensive patients with a history of stroke.
- Lowering BP to <130/80 mm Hg may be a beneficial target for secondary prevention in this high-risk population.
Background:
This study investigated whether a mean blood pressure (BP) of <130/80 mm Hg is associated with further reduction in cardiovascular outcomes in treated hypertensive subjects with previous stroke.
Methods And Results:
Subjects from the Korea National Health Insurance Service health examinee cohort diagnosed as having stroke and hypertension from January 1st, 2003 and December 31st, 2006 (N=2320) were grouped according to mean systolic (<130, 130-<140, and ≥140 mm Hg) and diastolic (<80, 80-<90, and ≥90 mm Hg) BP recorded during follow-up health examinations. All-cause and cardiovascular mortality over 11 years were compared. Compared with subjects with a systolic BP of ≥140 mm Hg (N=736), subjects with a systolic BP of 130 to <140 mm Hg (N=793) had a significantly lower risk of all-cause death (hazard ratio [HR], 0.61; 95% confidence interval [CI], 0.47-0.79; P<0.001), cardiovascular mortality (HR, 0.39; 95% CI, 0.25-0.61; P<0.001), and fatal ischemic stroke (HR, 0.25; 95% CI, 0.10-0.63; P=0.003). Systolic BP of <130 mm Hg (N=791) was associated with lower risk of nonfatal hemorrhagic stroke. Subjects with a diastolic BP of 80 to <90 mm Hg (N=1100) had significantly lower risk of all-cause death (HR, 0.60, 95% CI, 0.45-0.80; P<0.001) and cardiovascular mortality (HR, 0.45; 95% CI, 0.30-0.70; P<0.001) than those with a diastolic BP of ≥90 mm Hg (N=342). Diastolic BP of <80 mm Hg (N=878) was associated with reduced risk of nonfatal hemorrhagic stroke and further lowering of all-cause mortality and cardiovascular mortality.
Conclusions:
BP of <130/80 mm Hg was associated with improved outcomes in hypertensive subjects with previous stroke.
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