Trajectory Groups of 24-Hour Systolic Blood Pressure After Acute Ischemic Stroke and Recurrent Vascular Events

• Published in: Stroke (1970) Vol. 49; no. 8; pp. 1836 - 1842
• Main Authors: Kim, Beom Joon, Cho, Yong-Jin, Hong, Keun-Sik, Lee, Jun, Kim, Joon-Tae, Choi, Kang Ho, Park, Tai Hwan, Park, Sang-Soon, Park, Jong-Moo, Kang, Kyusik, Lee, Soo Joo, Kim, Jae Guk, Cha, Jae-Kwan, Kim, Dae-Hyun, Nah, Hyun-Wook, Lee, Byung-Chul, Yu, Kyung-Ho, Oh, Mi-Sun, Kim, Dong-Eog, Ryu, Wi-Sun, Choi, Jay Chol, Kim, Wook-Joo, Shin, Dong-Ick, Yeo, Min-Ju, Sohn, Sung Il, Hong, Jeong-Ho, Lee, Ji Sung, Lee, Juneyoung, Han, Moon-Ku, Gorelick, Philip B., Bae, Hee-Joon
• Format: Journal Article
• Language: English
• Published: United States American Heart Association, Inc 01.08.2018
• Subjects: Aged; Aged, 80 and over; Blood Pressure - physiology; Blood Pressure Determination - methods; Blood Pressure Determination - trends; Brain Ischemia - diagnosis; Brain Ischemia - epidemiology; Brain Ischemia - physiopathology; Female; Humans; Male; Middle Aged; Prospective Studies; Recurrence; Registries; Republic of Korea - epidemiology; Risk Factors; Stroke - diagnosis; Stroke - epidemiology; Stroke - physiopathology; Time Factors; Republic of Korea; blood pressure; brain ischemia; death; humans; stroke
• ISSN: 0039-2499; 1524-4628; 1524-4628
• DOI: 10.1161/STROKEAHA.118.021117

BACKGROUND AND PURPOSE—Blood pressure dynamics in patients with acute ischemic stroke may serve as an important modifiable and prognostic factor. METHODS—A total of 8376 patients with acute ischemic stroke were studied from a prospective multicenter registry. Patients were eligible if they had been admitted within 24 hours of symptom onset and had ≥5 systolic blood pressure (SBP) measurements during the first 24 hours of hospitalization. SBP trajectory groups in the first 24 hours were identified using the TRAJ procedure in SAS software with delta-Bayesian Information Criterion and prespecified modeling parameters. Vascular events, including recurrent stroke, myocardial infarction, and death, were prospectively collected. The risk of having vascular events was calculated using the frailty model to adjust for clustering by hospital. RESULTS—The group-based trajectory model classified patients with acute ischemic stroke into 5 SBP trajectory groupslow (22.3%), moderate (40.8%), rapidly stabilized (11.9%), acutely elevated (18.5%), and persistently high (6.4%) SBP. The risk of having vascular events was increased in the acutely elevated (hazard ratio, 1.28 [95% confidence interval, 1.12–1.47]) and the persistently high SBP groups (hazard ratio, 1.67 [95% confidence interval, 1.37–2.04]) but not in the rapidly stabilized group (hazard ratio, 1.13 [95% confidence interval, 0.95–1.34]), when compared with the moderate SBP group. CONCLUSIONS—SBP during the first 24 hours after acute ischemic stroke may be categorized into distinct trajectory groups, which differ in relation to stroke characteristics and frequency of subsequent recurrent vascular event risks. The findings may help to recognize potential candidates for future blood pressure control trials.