title: Lower systolic blood pressure is associated with poorer survival in long-term survivors of stroke.
abstract: BACKGROUND
  Lowering blood pressure after stroke reduces the risk of recurrent stroke and other vascular events. However, there is recent evidence that low blood pressure may also result in poor outcome. For the first time, this study aimed to investigate the relationship between blood pressure and outcome in long-term survivors of stroke.
  
  
  METHODS
  Participants from the North East Melbourne Stroke Incidence Study were contacted at 5 years after stroke for a follow-up assessment. Blood pressure was measured according to a strict protocol. A multivariable Cox proportional hazards regression model was used to assess the association between SBP measurements at 5 years after stroke and outcome (death, acute myocardial infarction or recurrent stroke) to 10 years after stroke.
  
  
  RESULTS
  In 5-year survivors of stroke, compared to a SBP of 131-141 mmHg, a SBP of 120 mmHg or less was associated with a 61% greater risk of stroke, acute myocardial infarction and death (hazard ratio 1.61, 95% confidence interval 1.08-2.41, P = 0.019). Compared to the reference category of SBP 131-141  mmHg, there were no differences in outcome in the patients with SBP 121-130  mmHg (P = 0.491) or 142-210  mmHg (P = 0.313). These findings were not modified when adjusting for prescription of antihypertensive medications.
  
  
  CONCLUSIONS
  There was a greater risk of poor outcome in long-term survivors of stroke with low SBP. This is further evidence that low SBP may result in poor prognosis. Ideal blood pressure levels for long-term survivors of stroke may need to be reassessed.
authors: aStroke and Ageing Research Unit 2, Department of Medicine, Southern Clinical School, Monash University, Melbourne bMenzies Research Institute Tasmania, University of Tasmania, Hobart cFlorey Neuroscience Institutes, Heidelberg, Victoria, Australia.
authors: Joosup
authors: J
authors: Kim
authors: Seana L
authors: SL
authors: Gall
authors: Mark R
authors: MR
authors: Nelson
authors: James E
authors: JE
authors: Sharman
authors: Amanda G
authors: AG
authors: Thrift
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D001795:Blood Pressure Determination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012307:Risk Factors; D012923:Social Class; D020521:Stroke / Q000401:mortality* / Q000503:physiopathology*; D013599:Systole; D013997:Time Factors; D016896:Treatment Outcome