To determine whether achieving the 2017 American College of Cardiology /American Heart Association (ACC/AHA) hypertension guideline recommended blood pressure (BP) goal (i.e., <130/80 mmHg) confers an incremental mortality benefit for patients with ischemic stroke/transient ischemic attack (TIA) compared both to patients not achieving ACC/AHA goal but achieving Joint National Committee (JNC)-8 recommended BP (i.e., <140/90 mmHg) and those achieving neither goal BP.

A VA stroke/TIA administrative dataset which included Veterans who received their longitudinal outpatient primary care within a Veterans Administration Medical Center (VAMC) between 10/2014-9/2018 (N=34,688) was used. We selected patients from 10/2015-9/2017 who had follow-up data until 9/2018, thereby allowing for at least 1-year follow-up. Patients with missing BP values or receiving care at a VAMC which had an ongoing quality improvement project directed at improving BP were excluded. Goal BP was calculated at 90-days after discharge and included 3 mutually exclusive categories: achieving ACC/AHA goal, not achieving ACC/AHA though achieving JNC goal, not achieving either goal. Multivariate logistic regression was used to examine the relationship between BP control 90-days post-discharge with 1-year mortality, adjusting for age, cerebrovascular event type, comorbidities, and health care utilization. 

Among 10,822 eligible patients, 40.2% obtained ACC/AHA goal BP by 90-days post-event, whereas 33.55% achieved JNC-8 but not ACC/AHA goal BP. In adjusted analyses, patients achieving ACC/AHA BP goal experienced a borderline significant 1-year mortality benefit (adjusted odds ratio [aOR]: 1.24, Confidence Interval [CI]: 1.00-1.54; p=0.053), whereas there was no mortality benefit with higher BPs, including JNC-8 goal (C-index: 0.76).

In this observational cohort study of patients with cerebrovascular disease, achieving ACC/AHA goal BP by 90-days post-event was marginally associated with improved 1-year mortality, whereas achieving other degrees of BP did not confer mortality benefit.