Systolic Blood Pressure Control and Mortality After Stroke in Hypertensive Patients

Abstract

Background and Purpose-Hypertensive patients with electrocardiographic left ventricular hypertrophy are at increased risk of all-cause and cardiovascular death. Lowering blood pressure (BP) after stroke reduces the risk of recurrent stroke, but recent data suggest that lower systolic BP (SBP) measured 5 years after stroke is associated with increased mortality. Whether lower SBP is associated with increased short-term mortality after stroke in hypertensive patients is unclear. Methods-All-cause and cardiovascular mortality were examined in relation to average on-treatment SBP after stroke in 541 hypertensive patients with electrocardiographic left ventricular hypertrophy randomly assigned to losartan-or atenololbased treatment who had new strokes during follow-up. Patients with on-treatment SBP<144 mm Hg (lowest tertile) and SBP>157 (highest tertile) were compared with patients with average SBP between 144 and 157. Results-During 2.02±1.65 years mean follow-up after incident stroke, 170 patients (31.4%) died, 135 (25.0%) from cardiovascular causes. In multivariate Cox analyses, adjusting for significant univariate predictors of mortality, compared with average SBP between 144 and 157, an average SBP<144 was a significant predictor of all-cause (hazard ratio, 1.81; 95% confidence interval, 1.20-2.73) and cardiovascular mortality (hazard ratio, 1.60; 95% confidence interval, 1.02-2.54), whereas patients who had an average SBP>157 had no significant increased risk of death. Conclusions-Lower achieved SBP (<144 mm Hg) is associated with a significantly increased risk of cardiovascular and all-cause mortality after initial stroke in hypertensive patients during short-term follow-up. Further study is required to determine ideal SBP goals after stroke. Clinical Trial Registration

Astrocyte‐specific insulin‐like growth factor‐1 gene transfer in aging female rats improves stroke outcomes

“…These data support the hypothesis that elevating IGF-1 expression in astrocytes significantly improves stroke outcomes after transient ischemia-reperfusion in middle-aged female SD rats. AAV5 mediatedexpression of hIGF-1 in astrocytes reduced stroke-induced motor while controls experienced a decrease in systolic blood pressure after stroke, which is associated with poorer clinical outcomes and increased mortality in stroke patients (Lin, Ovbiagele, Markovic, & Towfighi, 2015;Okin, Kjeldsen, & Devereux, 2015) especially in the acute period of stroke (Wohlfahrt et al, 2015). These novel findings are in accordance with a growing body of evidence that functional modifications of astrocytes yields major benefits for neurodegenerative diseases (Bajenaru, Zhu, Hedrick, Donahoe, Parada, & Gutmann, 2002;Furman et al, 2012Furman et al, , 2016.…”

“…AAV5 mediated-expression of hIGF-1 in astrocytes reduced stroke-induced motor impairment, improved sensory motor performance and preferential transmigration of immune cells associated with protective or anti-inflammatory actions. Additionally, systolic blood pressure was stable after transient MCAo in animals with replenished astrocyte IGF-1, while controls experienced a decrease in systolic blood pressure after stroke, which is associated with poorer clinical outcomes and increased mortality in stroke patients (Lin et al 2015; Okin et al 2015) especially in the acute period of stroke (Wohlfahrt et al 2015). These novel findings are in accordance with a growing body of evidence that functional modifications of astrocytes yields major benefits for neurodegenerative diseases (Bajenaru et al 2002; Furman et al 2012; Furman et al 2016).…”

The J-Curve Association Between Blood Pressure and Mortality in Stroke Survivors

“…Our findings are consistent with previous data reporting the association of all-cause mortality with SBP in adults with self-reported stroke of NHNSE 1998–2004, 13 and Hypertensive patients with electrocardiographic left ventricular hypertrophy. 14 Also add information on the association of all-cause mortality with elevated DBP to the available literature on this topic. Our results also highlight the optimal BP targets.…”

The safety and efficacy of dexmedetomidine versus propofol for patients undergoing endovascular therapy for acute stroke

“…[27,28] Previous studies also imply higher blood pressures were associated with higher incidences of death whereas lower blood pressures correlated with coronary artery disease. [29,30] As a result, it is very important to maintain both, the adequate perfusion pressure and reduce the time of hypotension, especially before recanalization. A previous study has reported that more than 70% of stroke patients had blood pressure greater than 170/110 mm Hg.…”