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Blood Pressure Level and Outcomes in Adults Aged 65 and Older with Prior Ischemic Stroke

Authors

  • Robert C. Kaplan PhD,

    1. From the *Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York; Departments of Neurology, Epidemiology, §Medicine, and Health Services, University of Washington, Seattle, WashingtonEpidemiology and Biometry Program, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland#Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina**Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
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  • David L. Tirschwell MD,

    1. From the *Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York; Departments of Neurology, Epidemiology, §Medicine, and Health Services, University of Washington, Seattle, WashingtonEpidemiology and Biometry Program, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland#Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina**Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
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  • W.T. Longstreth Jr. MD, MPH,

    1. From the *Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York; Departments of Neurology, Epidemiology, §Medicine, and Health Services, University of Washington, Seattle, WashingtonEpidemiology and Biometry Program, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland#Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina**Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
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  • Teri A. Manolio MD, PhD,

    1. From the *Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York; Departments of Neurology, Epidemiology, §Medicine, and Health Services, University of Washington, Seattle, WashingtonEpidemiology and Biometry Program, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland#Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina**Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
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  • Susan R. Heckbert MD, PhD,

    1. From the *Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York; Departments of Neurology, Epidemiology, §Medicine, and Health Services, University of Washington, Seattle, WashingtonEpidemiology and Biometry Program, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland#Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina**Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
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  • Aaron J. LeValley MS,

    1. From the *Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York; Departments of Neurology, Epidemiology, §Medicine, and Health Services, University of Washington, Seattle, WashingtonEpidemiology and Biometry Program, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland#Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina**Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
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  • David Lefkowitz MD,

    1. From the *Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York; Departments of Neurology, Epidemiology, §Medicine, and Health Services, University of Washington, Seattle, WashingtonEpidemiology and Biometry Program, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland#Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina**Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
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  • Aiman El-Saed MD,

    1. From the *Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York; Departments of Neurology, Epidemiology, §Medicine, and Health Services, University of Washington, Seattle, WashingtonEpidemiology and Biometry Program, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland#Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina**Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
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  • Bruce M. Psaty MD, PhD

    1. From the *Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York; Departments of Neurology, Epidemiology, §Medicine, and Health Services, University of Washington, Seattle, WashingtonEpidemiology and Biometry Program, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland#Department of Neurology, Wake Forest University School of Medicine, Winston-Salem, North Carolina**Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
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Address correspondence to Robert C. Kaplan, PhD, Department of Epidemiology and Population Health, Belfer Building, Room 1306C, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461. E-mail: rkaplan@aecom.yu.edu

Abstract

OBJECTIVES: To examine the association between blood pressure (BP) levels and long-term stroke outcomes in elderly stroke survivors.

DESIGN: Observational study.

SETTING: The Cardiovascular Health Study (CHS) of 5,888 community-dwelling adults.

PARTICIPANTS: Two hundred fifty-four adults aged 65 and older (mean age 78.6) who sustained a nonfatal first ischemic stroke.

MEASUREMENTS: 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.

CONCLUSION: 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.

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