title: Systolic Blood Pressure Control and Mortality After Stroke in Hypertensive Patients.
abstract: OBJECTIVE
  Hypertensive patients with electrocardiographic left ventricular hypertrophy are at increased risk of all-cause and cardiovascular death. Lowering blood pressure (BP) after stroke reduces the risk of recurrent stroke, but recent data suggest that lower systolic BP (SBP) measured 5 years after stroke is associated with increased mortality. Whether lower SBP is associated with increased short-term mortality after stroke in hypertensive patients is unclear.
  
  
  METHODS
  All-cause and cardiovascular mortality were examined in relation to average on-treatment SBP after stroke in 541 hypertensive patients with electrocardiographic left ventricular hypertrophy randomly assigned to losartan- or atenolol-based treatment who had new strokes during follow-up. Patients with on-treatment SBP<144 mm Hg (lowest tertile) and SBP>157 (highest tertile) were compared with patients with average SBP between 144 and 157.
  
  
  RESULTS
  During 2.02±1.65 years mean follow-up after incident stroke, 170 patients (31.4%) died, 135 (25.0%) from cardiovascular causes. In multivariate Cox analyses, adjusting for significant univariate predictors of mortality, compared with average SBP between 144 and 157, an average SBP<144 was a significant predictor of all-cause (hazard ratio, 1.81; 95% confidence interval, 1.20-2.73) and cardiovascular mortality (hazard ratio, 1.60; 95% confidence interval, 1.02-2.54), whereas patients who had an average SBP>157 had no significant increased risk of death.
  
  
  CONCLUSIONS
  Lower achieved SBP (<144 mm Hg) is associated with a significantly increased risk of cardiovascular and all-cause mortality after initial stroke in hypertensive patients during short-term follow-up. Further study is required to determine ideal SBP goals after stroke.
  
  
  BACKGROUND
  URL: http://clinicaltrials.gov/. Unique identifier: NCT00338260.
authors.affiliation: From the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY (P.M.O., R.B.D.); Department of Cardiology, University of Oslo, Ullevål Hospital, Oslo, Norway (S.E.K.); and Department of Medicine, University of Michigan Medical Center, Ann Arbor (S.E.K.). pokin@med.cornell.edu.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Okin
authors.affiliation: From the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY (P.M.O., R.B.D.); Department of Cardiology, University of Oslo, Ullevål Hospital, Oslo, Norway (S.E.K.); and Department of Medicine, University of Michigan Medical Center, Ann Arbor (S.E.K.).
authors.forename: Sverre E
authors.initials: SE
authors.lastname: Kjeldsen
authors.affiliation: From the Greenberg Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY (P.M.O., R.B.D.); Department of Cardiology, University of Oslo, Ullevål Hospital, Oslo, Norway (S.E.K.); and Department of Medicine, University of Michigan Medical Center, Ann Arbor (S.E.K.).
authors.forename: Richard B
authors.initials: RB
authors.lastname: Devereux
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D011446:Prospective Studies; D020521:Stroke / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D016896:Treatment Outcome
keywords: blood pressure; electrocardiography; hypertension; hypertrophy; stroke