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Relation Between Blood Pressure and Clinical Outcome in Hypertensive Subjects With Previous Stroke

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      Abstract

      Background

      This study investigated whether a mean blood pressure (BP) of <130/80 mm Hg is associated with further reduction in cardiovascular outcomes in treated hypertensive subjects with previous stroke.

      Methods and Results

      Subjects from the Korea National Health Insurance Service health examinee cohort diagnosed as having stroke and hypertension from January 1st, 2003 and December 31st, 2006 (N=2320) were grouped according to mean systolic (<130, 130–<140, and ≥140 mm Hg) and diastolic (<80, 80–<90, and ≥90 mm Hg) BP recorded during follow‐up health examinations. All‐cause and cardiovascular mortality over 11 years were compared. Compared with subjects with a systolic BP of ≥140 mm Hg (N=736), subjects with a systolic BP of 130 to <140 mm Hg (N=793) had a significantly lower risk of all‐cause death (hazard ratio [ HR], 0.61; 95% confidence interval [CI], 0.47–0.79; P<0.001), cardiovascular mortality ( HR, 0.39; 95% CI, 0.25–0.61; P<0.001), and fatal ischemic stroke ( HR, 0.25; 95% CI, 0.10–0.63; P=0.003). Systolic BP of <130 mm Hg (N=791) was associated with lower risk of nonfatal hemorrhagic stroke. Subjects with a diastolic BP of 80 to <90 mm Hg (N=1100) had significantly lower risk of all‐cause death ( HR, 0.60, 95% CI, 0.45–0.80; P<0.001) and cardiovascular mortality ( HR, 0.45; 95% CI, 0.30–0.70; P<0.001) than those with a diastolic BP of ≥90 mm Hg (N=342). Diastolic BP of <80 mm Hg (N=878) was associated with reduced risk of nonfatal hemorrhagic stroke and further lowering of all‐cause mortality and cardiovascular mortality.

      Conclusions

      BP of <130/80 mm Hg was associated with improved outcomes in hypertensive subjects with previous stroke.

      Related collections

      Most cited references 22

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      A Randomized Trial of Intensive versus Standard Blood-Pressure Control.

      The most appropriate targets for systolic blood pressure to reduce cardiovascular morbidity and mortality among persons without diabetes remain uncertain.
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        Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.

        The aim of this updated guideline is to provide comprehensive and timely evidence-based recommendations on the prevention of future stroke among survivors of ischemic stroke or transient ischemic attack. The guideline is addressed to all clinicians who manage secondary prevention for these patients. Evidence-based recommendations are provided for control of risk factors, intervention for vascular obstruction, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke. Recommendations are also provided for the prevention of recurrent stroke in a variety of specific circumstances, including aortic arch atherosclerosis, arterial dissection, patent foramen ovale, hyperhomocysteinemia, hypercoagulable states, antiphospholipid antibody syndrome, sickle cell disease, cerebral venous sinus thrombosis, and pregnancy. Special sections address use of antithrombotic and anticoagulation therapy after an intracranial hemorrhage and implementation of guidelines. © 2014 American Heart Association, Inc.
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          Effects of intensive blood-pressure control in type 2 diabetes mellitus.

           ,  Martin L Katz,  H Grimm (2010)
          There is no evidence from randomized trials to support a strategy of lowering systolic blood pressure below 135 to 140 mm Hg in persons with type 2 diabetes mellitus. We investigated whether therapy targeting normal systolic pressure (i.e., <120 mm Hg) reduces major cardiovascular events in participants with type 2 diabetes at high risk for cardiovascular events. A total of 4733 participants with type 2 diabetes were randomly assigned to intensive therapy, targeting a systolic pressure of less than 120 mm Hg, or standard therapy, targeting a systolic pressure of less than 140 mm Hg. The primary composite outcome was nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes. The mean follow-up was 4.7 years. After 1 year, the mean systolic blood pressure was 119.3 mm Hg in the intensive-therapy group and 133.5 mm Hg in the standard-therapy group. The annual rate of the primary outcome was 1.87% in the intensive-therapy group and 2.09% in the standard-therapy group (hazard ratio with intensive therapy, 0.88; 95% confidence interval [CI], 0.73 to 1.06; P=0.20). The annual rates of death from any cause were 1.28% and 1.19% in the two groups, respectively (hazard ratio, 1.07; 95% CI, 0.85 to 1.35; P=0.55). The annual rates of stroke, a prespecified secondary outcome, were 0.32% and 0.53% in the two groups, respectively (hazard ratio, 0.59; 95% CI, 0.39 to 0.89; P=0.01). Serious adverse events attributed to antihypertensive treatment occurred in 77 of the 2362 participants in the intensive-therapy group (3.3%) and 30 of the 2371 participants in the standard-therapy group (1.3%) (P<0.001). In patients with type 2 diabetes at high risk for cardiovascular events, targeting a systolic blood pressure of less than 120 mm Hg, as compared with less than 140 mm Hg, did not reduce the rate of a composite outcome of fatal and nonfatal major cardiovascular events. (ClinicalTrials.gov number, NCT00000620.) 2010 Massachusetts Medical Society
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            Author and article information

            Affiliations
            [ 1 ] Department of Health Promotion Severance Hospital Seoul Korea
            [ 2 ] Department of Computer Science and Statistics Daegu University Gyeongbuk Korea
            [ 3 ] Cardiology Division Severance Cardiovascular Hospital and Cardiovascular Research Institute Yonsei University College of Medicine Seoul Korea
            [ 4 ] Department of Preventive Medicine Yonsei University College of Medicine Seoul Korea
            Author notes
            [* ] Correspondence to: Sungha Park, MD, PhD, Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50‐1 Yonsei‐ro, Seodaemun‐gu, Seoul 120‐752, Korea. E‐mail: shpark0530@ 123456yuhs.ac
            [†]

            Dr Chan Joo Lee and Dr Hwang contributed equally to this work.

            Contributors
            shpark0530@yuhs.ac
            Journal
            J Am Heart Assoc
            J Am Heart Assoc
            10.1002/(ISSN)2047-9980
            JAH3
            ahaoa
            Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
            John Wiley and Sons Inc. (Hoboken )
            2047-9980
            06 December 2017
            December 2017
            : 6
            : 12 ( doiID: 10.1002/jah3.2017.6.issue-12 )
            29212651
            5779023
            10.1161/JAHA.117.007102
            JAH32792
            © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

            This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

            Counts
            Figures: 2, Tables: 6, Pages: 15, Words: 10442
            Product
            Funding
            Funded by: Korea Health Industry Development Institute
            Funded by: Ministry of Health and Welfare, Republic of Korea
            Award ID: HI13C0715
            Funded by: National Health Insurance Service
            Award ID: NHIS‐2017‐2‐283
            Categories
            Original Research
            Original Research
            Epidemiology
            Custom metadata
            2.0
            jah32792
            December 2017
            Converter:WILEY_ML3GV2_TO_NLMPMC version:5.2.8 mode:remove_FC converted:27.12.2017

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