Abstract WP391: Post-Stroke Diastolic Blood Pressure and Risk of Recurrent Vascular Events

Abstract

Background: Recent clinical trials and expert consensus guidelines have typically focused on the issue of systolic blood pressure (SBP) targets for reducing vascular risk. However, little is known about the relationship of diastolic BP (DBP) level with vascular outcomes after a stroke. Methods: We analyzed a multicenter trial dataset involving 3680 recent (<4 months) noncardioembolic stroke patients followed for 2 years. Subjects were categorized per mean DBP level (mm Hg) during follow-up: low-normal (<70), normal (70 to <80), high-normal (80 89), and high (>=90). Pulse pressure (PP) was prespecified by three categories of <60; 60 to <70; and >=70 mm Hg. Independent associations of mean DBP level with stroke, coronary heart disease, or vascular death as major vascular events (MVEs), and ischemic stroke were assessed. Results: MVEs occurred in 20.7% of the low-normal, 15.1% of the normal, 16.9% of the high-normal, and 19.2% of the high DBP groups; while stroke occurred in 9.9%, 6.8%, 8.5%, and 10.8%, respectively. Compared with the normal DBP group, risk of MVEs was higher in the low-normal DBP group (adjusted hazard ratio [AHR], 1.33; 95% CI, 1.04–1.71). Among those with SBP 120 to <140 mmHg, risk of MVEs (AHR, 1.89; 95% CI, 1.13-3.15), and stroke (AHR, 2.87; 95% CI, 1.48-5.53) was higher in subjects with PP >=70 (mean DBP, 62.4 ± 3.8) than those with the lowest PP (mean DBP, 78.0 ± 5.9); while among those with SBP <120 mm Hg, PP 60 to <70 (mean DBP, 52.7 ± 2.5) was associated with increased risk of stroke (AHR, 5.85; 95% CI, 1.25-27.5). Conclusion: DBP levels in the low-normal (<70 mm Hg) range, particularly accompanied by an increased PP of >60, confer increased future risk of MVEs and stroke, among patients with a recent noncardioembolic stroke.