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

Sico JJ, Hu X, Myers LJ, Levine D, Bravata DM, Arling GW. Real-world analysis of two ischaemic stroke and TIA systolic blood pressure goals on 12-month mortality and recurrent vascular events. Stroke and vascular neurology. 2024 Jan 8.

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Abstract:

INTRODUCTION: Whether obtaining the more intensive goal systolic blood pressure (SBP) of < 130?mm Hg, rather than a less intensive SBP goal of < 140?mm Hg poststroke/transient ischaemic attack (TIA) is associated with incremental mortality and recurrent vascular event benefit is largely unexplored using real-world data. Lowering SBP excessively may result in poorer outcomes. METHODS: This is a retrospective cohort study of 26?368 Veterans presenting to a Veterans Administration Medical Center (VAMC) with a stroke/TIA between October 2015 and July 2018. Patients were excluded from the study if they had missing or extreme BP values, receiving dialysis or palliative care, left against medical advice had a cancer diagnosis, were cared for in a VAMC enrolled in a stroke/TIA quality improvement initiative, died or had a cerebrovascular or cardiovascular event within 90 days after their index stroke/TIA. The analytical sample included 12?337 patients. Average SBP during 90 days after discharge was assessed in categories ( = 105?mm Hg, 106-115?mm Hg, 116-130?mm Hg, 131-140?mm Hg and > 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.