Archief Roodbont

Risk for a first ischemic stroke is generally proportional to the level of systolic blood pressure (BP), but optimal poststroke BP for prevention of recurrent stroke is less clear. To examine this issue, researchers conducted a post hoc analysis of data from a previously published secondary prevention study that involved about 20,000 patients (mean age, 66; two thirds men) with recent noncardioembolic ischemic stroke (JW Cardiol Aug 27 2008).

The original study addressed the role of various antiplatelet regimens, and BP was managed by investigators at their discretion. Patients were assessed several times during a mean follow-up of 2.5 years, during which the risk for recurrent stroke was about 8%. Compared with patients who had low-normal systolic BP (120–129 mm Hg), risk for recurrent stroke was elevated in patients whose mean systolic BP during the study was very low (<120 mm Hg; 29% relative increase), high (140–149 mm Hg; 23% increase), or very high (150 mm Hg; 108% increase); risk with high-normal systolic BP (130–139 mm Hg) was similar to that with low-normal BP. These analyses were adjusted for clinical and demographic factors.

Comment: These post hoc analyses are sufficiently strong to support a recommendation to maintain systolic BP in the normal range (120–139 mm Hg) –– but not lower — in stroke patients. However, rigorous prospective studies to confirm this conclusion are warranted.

— Thomas L. Schwenk, MD

Dr. Ovbiagele is an Associate Editor for Journal Watch Neurology but was not involved in the selection or summarization of this article.

Published in Journal Watch General Medicine December 20, 2011