Abstract 11259: Lower Achieved Systolic Pressure is Associated With Increased Short-Term Mortality After Stroke in Hypertensive Patients With Electrocardiographic Left Ventricular Hypertrophy
Background: Hypertensive patients with ECG left ventricular hypertrophy (LVH) are at increased risk of all-cause and cardiovascular (CV) mortality. 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 worse long-term outcomes. Whether lower SBP is associated with increased short-term mortality after stroke in hypertensive patients is unclear.
Methods: All-cause and CV mortality were examined in relation to average in-treatment SBP in 541 hypertensive patients with ECG LVH randomly assigned to losartan- or atenolol-based treatment who had new strokes during follow-up. Patients with average 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 first stroke, 170 patients (31.4%) died, 135 (25.0%) from CV causes. SBP <144 was associated with significantly higher all-cause mortality and SBP>157 with significantly higher all-cause and CV mortality rates than SBP between 144 and 157 (table), with the highest unadjusted mortality rates in patients with SBP >157. In univariate Cox analyses, compared with average SBP between 144 and 157, patients with SBP <144 had an increased risk of all-cause mortality and patients with average SBP >157 an increased risk of all-cause and CV mortality. In multivariate Cox analyses adjusting for significant univariate predictors of mortality (see table), an average SBP <144 was a significant predictor of all-cause and CV death, whereas patients who had an average SBP >157 had no significant increased risk of death.
Conclusions: Lower achieved SBP (<144) is associated with a significantly increased risk of CV 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.
Author Disclosures: P.M. Okin: Research Grant; Significant; Novartis Pharmaceuticals. Consultant/Advisory Board; Significant; Novartis Pharmaceuticals. S.E. Kjeldsen: Honoraria; Modest; Bayer, MSD, Novartis, Takeda. Consultant/Advisory Board; Modest; Bayer, Serodus, Takeda. Other; Modest; Gyldendal. R.B. Devereux: None.
- © 2014 by American Heart Association, Inc.