What is the clinical evidence from this study?

Study design: Cohort. Population: Ischemic stroke (n=11357). Intervention: Normal systolic blood pressure vs. Uncontrolled systolic blood pressure. Primary outcome: Recurrent stroke (HR 0.68, 95% CI 0.54-0.86, p=<0.05).

November 7, 2025Open Access

Long-term systolic blood pressure and cardiovascular risks among patients with ischemic stroke: a register-based cohort study

Q: What are the key findings of this study?

Maintaining a normal systolic blood pressure level one year after discharge reduced the risk of recurrent stroke by 32% (HR 0.68) compared to uncontrolled blood pressure in ischemic stroke patients.

CMChunbao MoSouthern University of Science and Technology XLXia LiUniversity of Science and Technology of China SWShuang WangQingdao University

Key Result

Maintaining a normal systolic blood pressure level one year after discharge reduced the risk of recurrent stroke by 32% (HR 0.68) compared to uncontrolled blood pressure in ischemic stroke patients.

Study Design

Type

Cohort (n=11,357)

Structured PICO

Does maintaining normal or high-normal long-term systolic blood pressure reduce the risk of recurrent stroke and MACE in patients with ischemic stroke?

Population

11,357 patients hospitalized with ischemic stroke (IS) in Shenzhen, China, mean age 64.0 years, 61.1% men. Key inclusion: at least three blood pressure measurements within one year after IS discharge. Key exclusion: aged <45 or >95 years, recurrent stroke/MACE/death within 12 months after first diagnosis.

Intervention

Normal systolic blood pressure (SBP) (mean 120 ± 10 mm Hg) or high-normal SBP (mean 132 ± 9 mm Hg) levels maintained over 1 year post-discharge, identified using group-based trajectory models.

Comparator

Uncontrolled SBP (mean 146 ± 14 mm Hg) maintained over 1 year post-discharge.

Outcome

Recurrent stroke and major adverse cardiovascular events (MACE; composite of recurrent stroke, ischemic heart disease, and heart failure) within a 36-month follow-up period.composite

Maintaining sustained normal or high-normal systolic blood pressure levels one year after discharge is associated with a reduced risk of recurrent stroke and MACE in patients with ischemic stroke.

Main Result

Effect estimate: HR 0.68 (95% CI 0.54-0.86)

Absolute Event Rate: 56.5% vs 73%

p-value: p=<0.05

Limitations

Lack of data on radiological features and biochemical indicators
Potential variations in blood pressure measurement protocols across medical settings
Outcomes ascertained only from inpatient or death records, potentially underestimating incidence
Potential residual confounding and immortal time bias
Findings based solely on a single city (Shenzhen, China), limiting generalizability

Abstract

Background: The impact of blood pressure fluctuations on the prognosis of stroke has been well documented, but little is known about the association between long-term systolic blood pressure (SBP) levels and the risks of cardiovascular outcomes in patients with ischemic stroke (IS). Methods: In this retrospective cohort study, we included a total of 11 357 eligible IS patients hospitalised in Shenzhen, China between 1 July 2017 and 1 October 2023. One-year levels of SBP after IS patient discharge were identified using group-based trajectory models (GBTM). Propensity score-overlap weighted Cox regression models were used to assess the associations between SBP levels and the risks of recurrent stroke and major adverse cardiovascular events (MACE; including recurrent stroke, ischemic heart disease, and heart failure) within a 36-month follow-up period, respectively. Furthermore, we quantitatively assessed the benefits potentially gained from optimal SBP levels by calculating age-scale restricted mean survival times. Results: Three one-year GBTM-derived SBP level patterns were identified: normal (n = 2120), high-normal (n = 7949), and uncontrolled SBP (n = 1288). During a median follow-up of 1.75 years, IS patients with normal and high-normal SBP were associated with lower risks of recurrent stroke or MACE, with weighted hazard ratios (95% confidence interval (CI)) ranging from 0.68 (95% CI = 0.54-0.86) to 0.89 (95% CI = 0.78-1.02), compared to those with uncontrolled SBP. Furthermore, IS patients aged 45 to 70 years with normal or high-normal SBP may derive greater health benefits, with the event-free survival time ranging from 7.12 to 0.27 years. Conclusions: Maintaining sustained normal or high-normal SBP levels one year after discharge may be associated with a reduced risk of adverse cardiovascular events and potentially yields greater health benefits for IS patients.

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