Assessing the applicability of 2017 ACC/AHA hypertension guidelines for secondary stroke prevention in the BOSS study

Area of Science:

• Cardiovascular Medicine
• Neurology
• Hypertension Management

Background:

• Stroke secondary prevention guidelines, such as the 2017 ACC/AHA, aim to reduce recurrent events.
• The Blood Pressure and Clinical Outcome in TIA or Ischemic Stroke (BOSS) study provides data on patients post-ischemic stroke or TIA.
• Applying new hypertension guidelines may reclassify a significant number of patients.

Purpose of the Study:

• To evaluate the feasibility and applicability of the 2017 ACC/AHA hypertension guidelines for secondary stroke prevention.
• To assess the association between blood pressure status at 3 months post-event and 1-year prognosis in ischemic stroke/TIA patients.

Main Methods:

• Patients from the BOSS study were categorized by blood pressure (BP) at 3 months post-event.
• Subgroups included: non-hypertension, BP <130/80, 130-139/80-89, and ≥140/90 mmHg.
• Primary outcome was any stroke within one year; secondary outcomes included recurrent stroke/TIA and poor functional outcome.

Main Results:

• Among 2341 patients, 1056 had uncontrolled hypertension at 90 days per new guidelines.
• Recurrent stroke risk was higher in BP <130/80 (aOR 2.42) and ≥140/90 mmHg (aOR 4.30) compared to non-hypertension.
• Blood pressure 130-139/80-89 mmHg did not show significantly worsened clinical outcomes compared to the non-hypertension group.

Conclusions:

• The prevalence of hypertension and uncontrolled BP is higher under the new ACC/AHA guidelines.
• The 130-139/80-89 mmHg BP category did not correlate with adverse outcomes, challenging current secondary prevention targets.
• Further research is needed to clarify optimal blood pressure goals for secondary stroke prevention.