Real-world analysis of two ischaemic stroke and TIA systolic blood pressure goals on 12-month mortality and recurrent vascular events

Introduction Whether obtaining the more intensive goal systolic blood pressure(SBP)of<130mm Hg,rather than a less intensive SBP goal of<140mm Hg poststroke/transient ischaemic attack(TIA)is associated with incremental mortality and recurrent vascular event benefit is largely unexplored using real-world data.Lowering SBP excessively may result in poorer outcomes.Methods This is a retrospective cohort study of 26368 Veterans presenting to a Veterans Administration Medical Center(VAMC)with a stroke/TIA between October 2015 and July 2018.Patients were excluded from the study if they had missing or extreme BP values,receiving dialysis or palliative care,left against medical advice had a cancer diagnosis,were cared for in a VAMC enrolled in a stroke/TIA quality improvement initiative,died or had a cerebrovascular or cardiovascular event within 90 days after their index stroke/TIA.The analytical sample included 12337 patients.Average SBP during 90 days after discharge was assessed in categories(≤105mm Hg,106–115mm Hg,116–130mm Hg,131–140mm Hg and>140mm Hg).Separate multivariable Cox proportional hazard regressions were used to examine the relationship between average SBP groups and time to:(1)mortality and(2)any recurrent vascular event,from 90 days to up to 365 days after discharge from the index emergency department visit or inpatient admission.Results Compared with those with SBP>140mm Hg,patients with SBP between 116 and 130mm Hg had a significantly lower risk of recurrent stroke/TIA(HR 0.77,95%CI 0.60 to 0.99)but not cardiovascular events.Patients with SBP lower than 105mm Hg,compared with those with>140mm Hg demonstrated a statistically significant higher risk of death(HR 2.07,95%CI 1.43 to 3.00),but no statistical differences were found in other SBP groups.Discussion Data support a more intensive SBP goal to prevent recurrent cerebrovascular events among stroke/TIA patients by 90 days poststroke/TIA compared with less intensive goal.Very low SBPs were associated with increased mortality risk.