Blood pressure level and outcomes in adults aged 65 and older with prior ischemic stroke.
OBJECTIVE
To examine the association between blood pressure (BP) levels and long-term stroke outcomes in elderly stroke survivors.


METHODS
Observational study.


METHODS
The Cardiovascular Health Study (CHS) of 5,888 community-dwelling adults.


METHODS
Two hundred fifty-four adults aged 65 and older (mean age 78.6) who sustained a nonfatal first ischemic stroke.


METHODS
BP levels assessed at prestroke and poststroke CHS visits were examined as predictors of stroke recurrence, coronary heart disease (CHD), combined vascular events (CVEs), and mortality.


RESULTS
Higher poststroke BP level, assessed 261.6 days (mean) after stroke, was associated with higher risk of stroke recurrence over 5.4 years (mean) of follow-up. The multivariate-adjusted hazard ratio for stroke recurrence was 1.42 (95% confidence interval (CI) = 1.03-1.99) per standard deviation (SD) of systolic BP (P = .04) and 1.39 (95% CI = 1.01-1.91) per SD of diastolic BP (P = .04). Mortality was significantly greater in patients with low or high poststroke BP than in those with intermediate BP. Poststroke BP was not associated with risk of CHD or CVE, although further analyses suggested that high systolic BP predicted CHD and CVE in younger but not older subjects. Prestroke BP did not predict poststroke outcomes.


CONCLUSIONS
In this observational study of adults aged 65 and older assessed approximately 8 months after stroke, low BP was associated with favorable risk of recurrent stroke, although high and low poststroke BP levels were associated with greater mortality. Long-term antihypertensive trials in older stroke survivors would increase knowledge about the benefits of lowering BP in this population.
Kaplan
Robert C
RC
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York 10461, USA. rkaplan@aecom.yu.edu
Tirschwell
David L
DL
Longstreth
W T
WT
Manolio
Teri A
TA
Heckbert
Susan R
SR
LeValley
Aaron J
AJ
Lefkowitz
David
D
El-Saed
Aiman
A
Psaty
Bruce M
BM
D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology*; D002545:Brain Ischemia / Q000150:complications / Q000401:mortality* / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012008:Recurrence; D020521:Stroke / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology*; D015996:Survival Rate