http://stroke.ahajournals.org/content/46/5/1307.abstract?etoc
Too Low, No Go?
- Michelle P. Lin, MD, MPH;
- Bruce Ovbiagele, MD, MSc, MAS;
- Daniela Markovic, MS;
- Amytis Towfighi, MD
+ Author Affiliations
- Correspondence to Michelle P. Lin, MD, MPH, Department of Neurology, University of Southern California, 1100 N State St A4E, Los Angeles, CA 90033. E-mail michelle.py.lin@gmail.com
Abstract
Background and Purpose—Recent studies suggest a J-shaped association between systolic blood pressure (SBP) and cardiovascular events. The optimal
SBP target after stroke remains unknown. We assessed the link between SBP and mortality after stroke.
Methods—We included
adults (≥20 years) with self-reported stroke who participated in the
National Health and Nutrition Examination
Surveys 1998 to 2004, with mortality
assessment in 2006. Baseline SBP was categorized as low to normal
(<120 mm Hg), normal
(120–140 mm Hg), and high (≥140 mm Hg).
Independent relationships between baseline SBP and all-cause and
vascular mortality
were assessed using Cox proportional hazards.
Results—Of 31 126
adult participants, 455 had self-reported stroke and baseline BP
readings: 19% had low to normal, 31% had normal,
and 50% had high SBP. Two years after
assessment, the low to normal SBP group tended to have the highest
cumulative all-cause
mortality (11.5%), compared with mortality
rates of 8.5% and 7.5% in the normal and high SBP groups, respectively.
Similar
patterns were seen with vascular mortality.
After adjusting for covariates, compared with the high SBP group, the
low to normal
group had higher all-cause mortality
(adjusted hazard ratio, 1.96; 95% confidence interval, 1.13–3.39; P=0.017) and trended toward higher vascular mortality (adjusted hazard ratio, 2.08; 95% confidence interval, 0.93–4.68; P=0.075). Compared with the normal BP group, the risk of all-cause and vascular mortality trended higher in low to normal BP
group but did not achieve statistical significance.
Conclusions—After stroke, compared with SBP in the high range, low to normal SBP is associated with poorer mortality outcomes.
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