Abstract Details

Title Baseline Low-Normal Systolic Blood Pressure May Be Associated with Poorer Mortality Outcomes among Persons with a History of Stroke

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P03 - (-)

Poster/Presentation
Number 153

Objective

Background BACKGROUND: Two recent post-hoc analyses of secondary stroke prevention trials indicated that contrary to widespread notions, low-normal SBP may not be linked to fewer recurrent vascular events among individuals with recent stroke; rather, SBP may have a J-shaped association with outcomes.

Design/Methods DESIGN/METHODS: Among adults (?20 years) with self-reported stroke who participated in the National Health and Nutrition Examination Surveys 1998 -2004, baseline SBP (mean of ?3 standardized measurements taken during a single encounter) were categorized as low-normal (<120 mm Hg), normal (120-140 mm Hg), and high (?140 mm Hg). Mortality was assessed in 2006. Independent relationships between baseline SBP and all-cause and vascular mortality were assessed using Cox proportional hazards.

Results RESULTS: Of 455 subjects, 19% had low-normal, 31% had normal, and 50% had high SBP. Several characteristics were comparable across groups, but age, frequency of hypertension, diabetes, and use of antihypertensive drugs rose from the low-normal to the high SBP group. Furthermore, those with high SBP were more likely female and Black. In unadjusted analyses, there were no significant differences in mortality between SBP groups. In multivariable analyses, compared to the normal SBP group, the low-normal and high groups had similar all-cause mortality and vascular mortality. However, the low-normal group had worse all-cause (HR 1.99, 95% CI 1.19-3.34, p=0.03) and vascular (HR 2.14, 95% CI 1.76-2.60, p<0.001) mortality compared to the high group.

Conclusions CONCLUSIONS: Among individuals with self-reported stroke, baseline SBP in the low-normal vs. high range is associated with higher mortality. These results support recent studies suggesting that very low SBP among patients with stroke may not necessarily be more beneficial.

Authors/Disclosures
Amy T. Towfighi, MD PRESENTER	Dr. Towfighi has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Law firms. The institution of Dr. Towfighi has received research support from NIH.
	No disclosure on file
Bruce I. Ovbiagele, MD, MSc, FAAN (San Francisco VA)	Dr. Ovbiagele has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Stroke Association. Dr. Ovbiagele has received research support from National Institutes of Health. Dr. Ovbiagele has a non-compensated relationship as a President with Society for Equity Neuroscience that is relevant to AAN interests or activities. Dr. Ovbiagele has a non-compensated relationship as a Board Member with World Stroke Organization that is relevant to AAN interests or activities.
	No disclosure on file

��ɫ��

��ɫ��