Key result
Post-discharge SBP 116–130 mmHg is linked to ~23% lower recurrent stroke or TIA risk.
Why the study?
Whether an intensive poststroke/TIA SBP goal of <130 mm Hg versus <140 mm Hg confers incremental mortality and recurrent vascular benefits remains largely unexplored in real-world data.
Does achieving a more intensive SBP goal (116-130 mm Hg) compared with a less intensive goal (>140 mm Hg) reduce 12-month mortality and recurrent vascular events in patients 90 days post-ischemic stroke or TIA?
Cohort (n=12,337)
Yes
Does achieving a more intensive SBP goal (116-130 mm Hg) compared with a less intensive goal (>140 mm Hg) reduce 12-month mortality and recurrent vascular events in patients 90 days post-ischemic stroke or TIA?
Achieving a more intensive SBP target of 116-130 mm Hg is associated with a reduced risk of recurrent cerebrovascular events post-stroke/TIA, while excessively low SBP (≤105 mm Hg) increases mortality.
SBP 116-130 mm Hg was associated with fewer recurrent events; hypothesis-generating and should not yet change practice pending RCTs.
INTRODUCTION: Whether obtaining the more intensive goal systolic blood pressure (SBP) of <130 mm Hg, rather than a less intensive SBP goal of <140 mm Hg poststroke/transient ischaemic attack (TIA) is associated with incremental mortality and recurrent vascular event benefit is largely unexplored using real-world data. Lowering SBP excessively may result in poorer outcomes. METHODS: This is a retrospective cohort study of 26 368 Veterans presenting to a Veterans Administration Medical Center (VAMC) with a stroke/TIA between October 2015 and July 2018. Patients were excluded from the study if they had missing or extreme BP values, receiving dialysis or palliative care, left against medical advice had a cancer diagnosis, were cared for in a VAMC enrolled in a stroke/TIA quality improvement initiative, died or had a cerebrovascular or cardiovascular event within 90 days after their index stroke/TIA. The analytical sample included 12 337 patients. Average SBP during 90 days after discharge was assessed in categories (≤105 mm Hg, 106-115 mm Hg, 116-130 mm Hg, 131-140 mm Hg and >140 mm Hg). Separate multivariable Cox proportional hazard regressions were used to examine the relationship between average SBP groups and time to: (1) mortality and (2) any recurrent vascular event, from 90 days to up to 365 days after discharge from the index emergency department visit or inpatient admission. RESULTS: Compared with those with SBP>140 mm Hg, patients with SBP between 116 and 130 mm Hg had a significantly lower risk of recurrent stroke/TIA (HR 0.77, 95% CI 0.60 to 0.99) but not cardiovascular events. Patients with SBP lower than 105 mm Hg, compared with those with >140 mm Hg demonstrated a statistically significant higher risk of death (HR 2.07, 95% CI 1.43 to 3.00), but no statistical differences were found in other SBP groups. DISCUSSION: Data support a more intensive SBP goal to prevent recurrent cerebrovascular events among stroke/TIA patients by 90 days poststroke/TIA compared with less intensive goal. Very low SBPs were associated with increased mortality risk.
No takes yet. Share an insight, caveat, or question.
Sico et al. (2024) conducted a cohort in Ischemic stroke or transient ischemic attack (TIA) (n=12,337). Average systolic blood pressure 116-130 mm Hg vs. Average systolic blood pressure >140 mm Hg was evaluated on Recurrent stroke/TIA at 12 months (HR 0.77, 95% CI 0.60 to 0.99). An average systolic blood pressure of 116-130 mm Hg reduced the risk of recurrent stroke or TIA compared to >140 mm Hg (HR 0.77), while very low SBP (≤105 mm Hg) significantly increased mortality risk.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: