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Randomized Controlled Trial
. 2019 Feb 12;32(3):317-325.
doi: 10.1093/ajh/hpy174.

Systolic Blood Pressure Trajectories in the Acute Phase and Clinical Outcomes in 2-Year Follow-up Among Patients With Ischemic Stroke

Changwei Li  1   2   3 , Yonghong Zhang  1   4 , Tan Xu  1   4 , Hao Peng  1   4 , Dali Wang  5 , Tian Xu  1   4   6 , Yingxian Sun  7 , Xiaoqing Bu  1 , Chung-Shiuan Chen  2 , Aili Wang  1   4 , Jinchao Wang  8 , Qunwei Li  9 , Zhong Ju  10 , Deqin Geng  11 , Jintao Zhang  12 , Jing Chen  2   5   13 , Jiang He  1   2   13   14 ; CATIS investigators
Affiliations
Randomized Controlled Trial

Systolic Blood Pressure Trajectories in the Acute Phase and Clinical Outcomes in 2-Year Follow-up Among Patients With Ischemic Stroke

Changwei Li et al. Am J Hypertens. .

Abstract

Background: Optimal blood pressure (BP) levels during acute ischemic stroke have not been established. We studied associations between systolic BP trajectories during acute phase and subsequent clinical outcomes among patients with ischemic stroke.

Methods: A total of 4,036 patients with acute ischemic stroke and elevated BP from the China Antihypertensive Trial in Acute Ischemic Stroke trial were included in this analysis. Three BPs were measured every 2 hours in day 1, every 4 hours during days 2 and 3, and every 8 hours thereafter until hospital discharge or death. Clinical outcomes were assessed at 3, 12, and 24 months. Latent variable mixture modeling was used to identify subgroups that share a similar underlying trajectory of systolic BP during the first 7 days after stroke onset. Logistic regression and Cox proportional hazards models were used to examine the associations between systolic BP trajectories and clinical outcomes during follow-up.

Results: We identified 5 systolic BP trajectories of high, high-to-moderate-low, moderate-high, moderate-low, and low. Compared to participants in high trajectory, multiple-adjusted odds ratios (95% confidence interval) of all-cause mortality at 3 months for individuals in high-to-moderate-low, moderate-high, moderate-low, and low were 0.34 (0.15-0.77), 0.58 (0.32-1.04), 0.29 (0.15-0.56), and 0.56 (0.26-1.19), respectively. Likewise, the corresponding hazard ratios for all-cause mortality in 24 months were 0.66 (0.44-1.00), 0.74 (0.53-1.05), 0.45 (0.32-0.66), and 0.61 (0.40-0.93), respectively. Similar associations were observed for recurrent stroke and cardiovascular disease, and in both the intervention and control groups.

Conclusions: Patients with moderate-low systolic BP during acute ischemic stroke had a lower risk of adverse clinical outcomes.

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Figures

Figure 1.
Figure 1.
Trajectories of systolic blood pressure among the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS) study participants. Three blood pressure measurements were obtained at baseline, every 2 hours for the first 24 hours after randomization, every 4 hours during the second and third days, and every 8 hours thereafter until hospital discharge or death. The mean of 3 systolic blood pressure measurements at each of the 36 time points was used to fit trajectories.
Figure 2.
Figure 2.
Cumulative risks of major clinical outcomes by systolic blood pressure trajectories among the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS) study participants. Cardiovascular disease included cardiovascular deaths, nonfatal stroke, nonfatal myocardial infarction, hospitalized and treated angina, hospitalized and treated congestive heart failure, and hospitalized and treated peripheral arterial disease.
See this image and copyright information in PMC

Comment in

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