Key result
Low initial SBP at stroke presentation is linked to ~40% higher risk of stroke-heart syndrome.
Why the study?
Adverse cardiac events following ischaemic stroke (stroke-heart syndrome, SHS) pose a clinical challenge, leading investigators to evaluate the association between initial blood pressure at presentation and SHS risk.
Does initial blood pressure at presentation associate with the risk of stroke-heart syndrome and 90-day mortality in patients with acute ischaemic stroke?
Cohort (n=14,965)
Yes
Does initial blood pressure at presentation associate with the risk of stroke-heart syndrome and 90-day mortality in patients with acute ischaemic stroke?
Initial blood pressure measurements at acute ischemic stroke presentation show a U-shaped association with subsequent stroke-heart syndrome and 90-day mortality, suggesting that extreme BP levels could help clinicians identify patients requiring targeted cardiac monitoring.
May prompt closer cardiac monitoring in acute ischemic stroke with SBP ≤130 mmHg; leaves open whether association is causal or modifiable.
Background: Adverse cardiac events following ischaemic stroke (stroke-heart syndrome, SHS) pose a clinical challenge. We investigated the association between initial blood pressure at stroke presentation and the risk of SHS. Methods: We utilised data from the Virtual International Stroke Trials Archive (VISTA). We defined SHS as the incidence of cardiac complications within 30 days post-ischaemic stroke. These presentations included acute coronary syndrome encompassing myocardial injury, heart failure/left ventricular dysfunction, atrial fibrillation/flutter, other arrhythmia/electrocardiogram abnormalities, and cardiorespiratory arrest. Using Cox proportional hazards models, we assessed the risk trajectories for developing SHS and its presentations associated with initial blood pressure. We also explored the risk trajectories for 90-day mortality related to initial blood pressure. Results: From 16,095 patients with acute ischaemic stroke, 14,965 (mean age 69 ± 12 years; 55% male) were analysed. Of these, 1774 (11.8%) developed SHS. The risk of SHS and initial blood pressure showed a U-shaped relationship. The lowest blood pressures (⩽130 mmHg systolic and ⩽55 mmHg diastolic) were associated with the highest risks (adjusted hazard ratio [95%confidence interval]: 1.40 [1.21–1.63]; p < 0.001, 1.71 [1.39–2.10]; p < 0.001, respectively, compared to referential blood pressure range). Cardiorespiratory arrest posed the greatest risk at higher blood pressure levels (2.34 [1.16–4.73]; p = 0.017 for systolic blood pressure >190 mmHg), whereas other presentations exhibited the highest risk at lower pressures. The 90-day mortality risk also followed a U-shaped distribution, with greater risks observed at high blood pressure thresholds. Conclusions: There is a U-shaped relationship between initial blood pressure at ischaemic stroke presentation and the risk of subsequent SHS.
No takes yet. Share an insight, caveat, or question.
Ishiguchi et al. (2024) conducted a cohort in Acute ischaemic stroke (n=14,965). Low initial blood pressure (≤130 mmHg systolic or ≤55 mmHg diastolic) vs. Reference initial blood pressure (>150 to ≤170 mmHg systolic, >75 to ≤95 mmHg diastolic) was evaluated on Stroke-heart syndrome (incidence of cardiac complications within 30 days post-stroke) (HR 1.40, 95% CI 1.21-1.63, p=<0.001). Low initial systolic blood pressure (≤130 mmHg) at acute stroke presentation was associated with an increased risk of stroke-heart syndrome compared to reference blood pressure levels (HR 1.40).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: