One-Year Blood Pressure Trajectory After Acute Ischemic Stroke.

Area of Science:

• Cardiovascular Medicine
• Neurology
• Public Health

Background:

• Blood pressure's effect on post-stroke outcomes is known, but long-term blood pressure trajectories and their impact after acute ischemic stroke remain understudied.
• Understanding these long-term patterns is crucial for improving patient management and prognosis.

Purpose of the Study:

• To identify distinct longitudinal systolic blood pressure (SBP) trajectories in the first year after acute ischemic stroke.
• To investigate the association between these SBP trajectories and major adverse cardiovascular outcomes.

Main Methods:

• Analysis of SBP measurements from 5514 patients with acute ischemic stroke in a multicenter prospective registry.
• Utilized a group-based trajectory model to categorize longitudinal SBPs over the first year post-stroke.
• Primary outcome: composite of stroke recurrence, myocardial infarction, and all-cause mortality within 1 year.

Main Results:

• Four distinct SBP trajectory groups were identified: low (27.0%), moderate (59.5%), persistently high (1.2%), and slowly dropping (12.4%).
• The slowly dropping SBP group showed a decrease from 182 to 135 mm Hg in the first 30 days.
• Compared to the moderate SBP group, the slowly dropping SBP group had a higher risk of the primary outcome (aHR, 1.32) and mortality (aHR, 1.35).
• The persistently high SBP group also exhibited similarly high rates for the primary outcome.

Conclusions:

• Identified four distinct 1-year longitudinal SBP trajectories in patients following acute ischemic stroke.
• Patients with slowly dropping or persistently high SBP trajectories face an elevated risk of adverse cardiovascular events and mortality post-stroke.