What question did this study set out to answer?

To determine whether maintaining lower blood pressure levels increases or decreases the risk of recurrent stroke following an initial event.

October 31, 2002StrokeOpen Access

Control of Hypertension and Risk of Stroke Recurrence

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Why the study?

Does lower follow-up blood pressure reduce the risk of stroke recurrence in patients with a recent initial stroke?

Population

662 patients enrolled within 1 month of an initial stroke from 8 acute care hospitals in Pennsylvania, USA.

Comparison

Lower follow-up blood pressure vs Higher follow-up blood pressure

Design

Cohort

Follow-up

up to 4 years

Authors

GFGary FridayCross-Cutting Cardiology MAMilton AlterLWL-Universitätsklinik Hamm SLSue‐Min LaiUniversity of Southern California

Discussion

Member takes

Implication

Higher BP associated with recurrence risk; hypothesis-generating for intensive targets post-stroke, pending RCTs.

Key Points

To determine whether maintaining lower blood pressure levels increases or decreases the risk of recurrent stroke following an initial event.
Prospective cohort study enrolling 662 patients within 1 month of an initial stroke across 8 acute care hospitals in Pennsylvania, followed semiannually for up to 4 years.
Blood pressure was tracked over follow-up (evaluated in 535 patients; mean age 71 years, 51% men) using both lowest and average measurements.
Multivariable Cox proportional hazards models assessed stroke recurrence while controlling for potential confounders including atrial fibrillation, diabetes, and cardiovascular history.
Over follow-up, 52 recurrent strokes occurred among 535 evaluated patients.
Stroke recurrence risk was significantly elevated for diastolic blood pressure ≥80 mm Hg compared with <80 mm Hg (RR 2.4; 95% CI, 1.38 to 4.27) and systolic blood pressure ≥140 mm Hg compared with <140 mm Hg (RR 2.4; 95% CI, 1.39 to 4.15).
Isolated systolic blood pressure (>140/<90 mm Hg) increased recurrence risk (RR 2.2; 95% CI, 1.23 to 3.79), while achieving at least one diastolic measurement <80 mm Hg reduced recurrence risk compared with levels of 80 to 90 mm Hg (RR 0.4; 95% CI, 0.21 to 0.88).

Structured PICO

Does lower follow-up blood pressure reduce the risk of stroke recurrence in patients with a recent initial stroke?

Population

662 patients enrolled within 1 month of an initial stroke (535 with follow-up blood pressure analyzed, mean age 71 years, 51% men) from 8 acute care hospitals in Pennsylvania, USA.

Intervention

Lower follow-up blood pressure (diastolic <80 mm Hg, systolic <140 mm Hg)

Comparator

Higher follow-up blood pressure (diastolic ≥80 mm Hg, systolic ≥140 mm Hg)

Outcome

Stroke recurrencehard clinical

Maintaining lower blood pressure (systolic <140 mm Hg and diastolic <80 mm Hg) significantly reduces the risk of stroke recurrence in patients with a recent initial stroke.

Cite This Study

Friday et al. (2002) studied this question.

synapsesocial.com/papers/6a756404f5fc394144035d9e https://doi.org/10.1161/01.str.0000033929.62136.6f

Topics

Hypertension management

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Control of Hypertension and Risk of Stroke Recurrence

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Control of Hypertension and Risk of Stroke Recurrence

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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