What is the clinical evidence from this study?

Study design: Cohort. Population: Stroke or Transient Ischemic Attack (TIA) (n=12337). Intervention: Average SBP 116-130 mm Hg vs. Average SBP >140 mm Hg. Primary outcome: Recurrent stroke/TIA (HR 0.77, 95% CI 0.60-0.99).

January 8, 2024Open Access

Real-world analysis of two ischaemic stroke and TIA systolic blood pressure goals on 12-month mortality and recurrent vascular events

JSJason J. SicoYale University XHXin HuAmerican Cancer Society LMLaura J. MyersRegenstrief Institute

Resultado clave

An average SBP of 116-130 mm Hg was associated with a lower risk of recurrent stroke or TIA compared to SBP >140 mm Hg (HR 0.77; 95% CI 0.60-0.99), whereas SBP <105 mm Hg increased mortality risk.

Diseño del estudio

Tipo

Cohort (n=12,337)

Multicéntrico

Sí

PICO estructurado

Does an intensive SBP goal (116-130 mm Hg) reduce mortality and recurrent vascular events in post-stroke/TIA patients compared to a less intensive goal (>140 mm Hg)?

Población

12,337 Veterans with a recent stroke or TIA who survived event-free for 90 days, followed for up to 365 days to assess the impact of average systolic blood pressure.

Exposición

Average systolic blood pressure (SBP) between 116 and 130 mm Hg during 90 days after discharge

Comparador

Average systolic blood pressure (SBP) >140 mm Hg during 90 days after discharge

Resultado

Time to mortality and time to any recurrent vascular event, from 90 days to up to 365 days after dischargehard clinical

An intensive SBP goal of 116-130 mm Hg post-stroke/TIA is associated with reduced recurrent cerebrovascular events, but excessively low SBP (<105 mm Hg) increases mortality risk.

Resultado numérico

Hazard Ratio: 0.77 (95% CI 0.6–0.99)

Resumen

INTRODUCTION: Whether obtaining the more intensive goal systolic blood pressure (SBP) of 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.

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