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Aortic and vascular disease
Original research
Twenty-four-hour blood pressure trajectories and clinical outcomes in patients who had an acute ischaemic stroke
  1. Ruirui Wang1,
  2. Yang Liu2,3,
  3. Qilu Zhang1,
  4. Jing Zhang1,
  5. Hao Peng1,
  6. Mengyao Shi1,
  7. Yanbo Peng4,
  8. Tian Xu5,
  9. Aili Wang1,
  10. Tan Xu1,
  11. Jing Chen3,6,
  12. Yonghong Zhang1,
  13. Jiang He3,6
  1. 1 Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, China
  2. 2 Department of Cardiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
  3. 3 Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
  4. 4 Department of Neurology, Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, China
  5. 5 Department of Neurology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
  6. 6 Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
  1. Correspondence to Professor Yonghong Zhang, Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Soochow University Medical College, Suzhou 215123, Jiangsu, China; yhzhang{at}suda.edu.cn

Abstract

Objective The management of blood pressure (BP) in acute ischaemic stroke remains a subject of controversy. This investigation aimed to explore the relationship between 24-hour BP patterns following ischaemic stroke and clinical outcomes.

Methods A cohort of 4069 patients who had an acute ischaemic stroke from 26 hospitals was examined. Five systolic BP trajectories were identified by using latent mixture modelling: trajectory category 5 (190–170 mm Hg), trajectory category 4 (180–140 mm Hg), trajectory category 3 (170–160 mm Hg), trajectory category 2 (155–145 mm Hg) and trajectory category 1 (150–130 mm Hg). The primary outcome was a composite outcome of death and major disability at 3 months poststroke.

Results Patients with trajectory category 5 exhibited the highest risk, while those with trajectory category 1 had the lowest risk of adverse outcomes at 3-month follow-up. Compared with the patients in the trajectory category 5, adjusted ORs (95% CIs) for the primary outcome were 0.79 (0.58 to 1.10), 0.70 (0.53 to 0.93), 0.64 (0.47 to 0.86) and 0.47 (0.33 to 0.66) among patients in trajectory category 4, trajectory category 3, trajectory category 2 and trajectory category 1, respectively. Similar trends were observed for death, vascular events and the composite outcome of death and vascular events.

Conclusion Patients with persistently high BP at 180 mm Hg within 24 hours of ischaemic stroke onset had the highest risk, while those maintaining stable BP at a moderate-low level (150 mm Hg) or even a low level (137 mm Hg) had more favourable outcomes.

  • Stroke
  • Hypertension
  • Epidemiology

Data availability statement

Data may be obtained from a third party and are not publicly available.

https://doi.org/10.1136/heartjnl-2023-323821

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    Data availability statement

    Data may be obtained from a third party and are not publicly available.

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    Footnotes

    • Contributors RW, JC, YZ and JH conceived and designed the study. HP, YP, TX, AW, TX and YZ supervised the data collection. RW, YL, QZ, JZ, MS and YZ analysed and interpreted the data. RW and YZ drafted the manuscript. All authors revised the manuscript and approved the final submitted version. YZ takes full responsibility for the work and the conduct of the study, had access to the data, and controlled the decision to publish.

    • Funding This study was supported by the National Natural Science Foundation of China (Grant No 82020108028).

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.