Association of systolic blood pressure after discharge and the risk of clinical outcomes in ischemic stroke patients with diabetes: a cohort study

• Published in: Chinese medical journal Vol. 136; no. 22; pp. 2765 - 2767
• Main Authors: Yang, Pinni, Zhu, Zhengbao, Wang, Shuyao, Shi, Mengyao, Peng, Yanbo, Zhong, Chongke, Wang, Aili, Xu, Tan, Peng, Hao, Xu, Tian, Zheng, Xiaowei, Chen, Jing, Zhang, Yonghong, He, Jiang
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 20.11.2023; Lippincott Williams & Wilkins Ovid Technologies; Wolters Kluwer
• Subjects: Blood pressure; Blood Pressure - physiology; Brain Ischemia; Cardiovascular disease; Clinical outcomes; Cohort Studies; Correspondence; Diabetes; Diabetes Mellitus; Disease prevention; Hospitalization; Humans; Hypertension; Ischemia; Ischemic Stroke; Kidney diseases; Medical prognosis; Metabolic disorders; Mortality; Patient Discharge; Stroke; United States > US; China
• ISSN: 0366-6999; 2542-5641; 2542-5641
• DOI: 10.1097/CM9.0000000000002819

Important covariates for the prognosis of ischemic stroke, including time from onset to hospitalization, baseline SBP, high-sensitivity C-reactive protein, eGFR, and NIHSS score at baseline, dyslipidemia, ischemic stroke subtypes, history of hypertension, history of coronary heart disease, family history of stroke, and receiving immediate BP reduction and occupation, were selected based on our prior knowledge and further included in the multivariable adjusted model. [...]the patients with a low-stable SBP trajectory had the lowest risk of unfavorable outcomes. [...]the patients with the high-decreasing trajectory had higher SBP levels at discharge that decreased to lower SBP levels in the late follow-up period than those with the moderate-increasing pattern but a lower risk of the unfavorable outcomes in the period from 12 to 24 months after stroke onset. In the Systolic Blood Pressure Intervention Trial (SPRINT) study, decreased risks of major cardiovascular events and all-cause mortality were found in the individuals randomized to intensive lowering BP treatment (SBP target <120 mmHg) compared with standard lowering BP treatment (SBP target <140 mmHg). Most recently, Zheng et al[6] reported that patients with a high-decreasing (SBP of 164 mmHg after discharge that decreased to 140 mmHg at 12 months) or low-stable SBP trajectory (SBP consistently <140 mmHg during the follow-up) from discharge to one year after stroke had a lower risk of unfavorable clinical outcomes among ischemic stroke patients, but the specific association of SBP trajectories with outcomes in ischemic stroke patients with diabetes was not observed in their analyses. [...]no guideline recommendations for BP control have been made for stroke patients with comorbid diabetes.