title: Blood pressure level and outcomes in adults aged 65 and older with prior ischemic stroke.
abstract: 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.
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York 10461, USA. rkaplan@aecom.yu.edu
authors.forename: Robert C
authors.initials: RC
authors.lastname: Kaplan
authors.forename: David L
authors.initials: DL
authors.lastname: Tirschwell
authors.forename: W T
authors.initials: WT
authors.lastname: Longstreth
authors.forename: Teri A
authors.initials: TA
authors.lastname: Manolio
authors.forename: Susan R
authors.initials: SR
authors.lastname: Heckbert
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: LeValley
authors.forename: David
authors.initials: D
authors.lastname: Lefkowitz
authors.forename: Aiman
authors.initials: A
authors.lastname: El-Saed
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Psaty
mesh_terms: 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