Blood pressure level and outcomes in adults aged 65 and older with prior ischemic stroke

Robert C. Kaplan, David L. Tirschwell, W. T. Longstreth, Teri A. Manolio, Susan R. Heckbert, Aaron J. LeValley, David Lefkowitz, Aiman El-Saed, Bruce M. Psaty

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

OBJECTIVES: To examine the association between blood pressure (BP) levels and long-term stroke outcomes in elderly stroke survivors. DESIGN: Observational study. SETTING: The Cardiovascular Health Study (CHS) of 5,888 community-dwelling adults. PARTICIPANTS: Two hundred fifty-four adults aged 65 and older (mean age 78.6) who sustained a nonfatal first ischemic stroke. MEASUREMENTS: BP levels assessed at prestroke and poststroke CHS visits were examined as predictors of stroke recurrence, coronary heart disease (CHD), combined vascular events (CVEs), and mortality. RESULTS: Higher poststroke BP level, assessed 261.6 days (mean) after stroke, was associated with higher risk of stroke recurrence over 5.4 years (mean) of follow-up. The multivariate-adjusted hazard ratio for stroke recurrence was 1.42 (95% confidence interval (CI)=1.03-1.99) per standard deviation (SD) of systolic BP (P=.04) and 1.39 (95% CI=1.01-1.91) per SD of diastolic BP (P=.04). Mortality was significantly greater in patients with low or high poststroke BP than in those with intermediate BP. Poststroke BP was not associated with risk of CHD or CVE, although further analyses suggested that high systolic BP predicted CHD and CVE in younger but not older subjects. Prestroke BP did not predict poststroke outcomes. CONCLUSION: In this observational study of adults aged 65 and older assessed approximately 8 months after stroke, low BP was associated with favorable risk of recurrent stroke, although high and low poststroke BP levels were associated with greater mortality. Long-term antihypertensive trials in older stroke survivors would increase knowledge about the benefits of lowering BP in this population.

Original languageEnglish (US)
Pages (from-to)1309-1316
Number of pages8
JournalJournal of the American Geriatrics Society
Volume54
Issue number9
DOIs
StatePublished - Sep 2006

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Stroke
Blood Pressure
Coronary Disease
Blood Vessels
Hypertension
Recurrence
Hypotension
Observational Studies
Survivors
Mortality
Confidence Intervals
Independent Living
Health
Antihypertensive Agents
Population

Keywords

  • Blood pressure
  • Prognosis
  • Stroke

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Kaplan, R. C., Tirschwell, D. L., Longstreth, W. T., Manolio, T. A., Heckbert, S. R., LeValley, A. J., ... Psaty, B. M. (2006). Blood pressure level and outcomes in adults aged 65 and older with prior ischemic stroke. Journal of the American Geriatrics Society, 54(9), 1309-1316. https://doi.org/10.1111/j.1532-5415.2006.00838.x

Blood pressure level and outcomes in adults aged 65 and older with prior ischemic stroke. / Kaplan, Robert C.; Tirschwell, David L.; Longstreth, W. T.; Manolio, Teri A.; Heckbert, Susan R.; LeValley, Aaron J.; Lefkowitz, David; El-Saed, Aiman; Psaty, Bruce M.

In: Journal of the American Geriatrics Society, Vol. 54, No. 9, 09.2006, p. 1309-1316.

Research output: Contribution to journalArticle

Kaplan, RC, Tirschwell, DL, Longstreth, WT, Manolio, TA, Heckbert, SR, LeValley, AJ, Lefkowitz, D, El-Saed, A & Psaty, BM 2006, 'Blood pressure level and outcomes in adults aged 65 and older with prior ischemic stroke', Journal of the American Geriatrics Society, vol. 54, no. 9, pp. 1309-1316. https://doi.org/10.1111/j.1532-5415.2006.00838.x
Kaplan, Robert C. ; Tirschwell, David L. ; Longstreth, W. T. ; Manolio, Teri A. ; Heckbert, Susan R. ; LeValley, Aaron J. ; Lefkowitz, David ; El-Saed, Aiman ; Psaty, Bruce M. / Blood pressure level and outcomes in adults aged 65 and older with prior ischemic stroke. In: Journal of the American Geriatrics Society. 2006 ; Vol. 54, No. 9. pp. 1309-1316.
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abstract = "OBJECTIVES: To examine the association between blood pressure (BP) levels and long-term stroke outcomes in elderly stroke survivors. DESIGN: Observational study. SETTING: The Cardiovascular Health Study (CHS) of 5,888 community-dwelling adults. PARTICIPANTS: Two hundred fifty-four adults aged 65 and older (mean age 78.6) who sustained a nonfatal first ischemic stroke. MEASUREMENTS: BP levels assessed at prestroke and poststroke CHS visits were examined as predictors of stroke recurrence, coronary heart disease (CHD), combined vascular events (CVEs), and mortality. RESULTS: Higher poststroke BP level, assessed 261.6 days (mean) after stroke, was associated with higher risk of stroke recurrence over 5.4 years (mean) of follow-up. The multivariate-adjusted hazard ratio for stroke recurrence was 1.42 (95{\%} confidence interval (CI)=1.03-1.99) per standard deviation (SD) of systolic BP (P=.04) and 1.39 (95{\%} CI=1.01-1.91) per SD of diastolic BP (P=.04). Mortality was significantly greater in patients with low or high poststroke BP than in those with intermediate BP. Poststroke BP was not associated with risk of CHD or CVE, although further analyses suggested that high systolic BP predicted CHD and CVE in younger but not older subjects. Prestroke BP did not predict poststroke outcomes. CONCLUSION: In this observational study of adults aged 65 and older assessed approximately 8 months after stroke, low BP was associated with favorable risk of recurrent stroke, although high and low poststroke BP levels were associated with greater mortality. Long-term antihypertensive trials in older stroke survivors would increase knowledge about the benefits of lowering BP in this population.",
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T1 - Blood pressure level and outcomes in adults aged 65 and older with prior ischemic stroke

AU - Kaplan, Robert C.

AU - Tirschwell, David L.

AU - Longstreth, W. T.

AU - Manolio, Teri A.

AU - Heckbert, Susan R.

AU - LeValley, Aaron J.

AU - Lefkowitz, David

AU - El-Saed, Aiman

AU - Psaty, Bruce M.

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N2 - OBJECTIVES: To examine the association between blood pressure (BP) levels and long-term stroke outcomes in elderly stroke survivors. DESIGN: Observational study. SETTING: The Cardiovascular Health Study (CHS) of 5,888 community-dwelling adults. PARTICIPANTS: Two hundred fifty-four adults aged 65 and older (mean age 78.6) who sustained a nonfatal first ischemic stroke. MEASUREMENTS: BP levels assessed at prestroke and poststroke CHS visits were examined as predictors of stroke recurrence, coronary heart disease (CHD), combined vascular events (CVEs), and mortality. RESULTS: Higher poststroke BP level, assessed 261.6 days (mean) after stroke, was associated with higher risk of stroke recurrence over 5.4 years (mean) of follow-up. The multivariate-adjusted hazard ratio for stroke recurrence was 1.42 (95% confidence interval (CI)=1.03-1.99) per standard deviation (SD) of systolic BP (P=.04) and 1.39 (95% CI=1.01-1.91) per SD of diastolic BP (P=.04). Mortality was significantly greater in patients with low or high poststroke BP than in those with intermediate BP. Poststroke BP was not associated with risk of CHD or CVE, although further analyses suggested that high systolic BP predicted CHD and CVE in younger but not older subjects. Prestroke BP did not predict poststroke outcomes. CONCLUSION: In this observational study of adults aged 65 and older assessed approximately 8 months after stroke, low BP was associated with favorable risk of recurrent stroke, although high and low poststroke BP levels were associated with greater mortality. Long-term antihypertensive trials in older stroke survivors would increase knowledge about the benefits of lowering BP in this population.

AB - OBJECTIVES: To examine the association between blood pressure (BP) levels and long-term stroke outcomes in elderly stroke survivors. DESIGN: Observational study. SETTING: The Cardiovascular Health Study (CHS) of 5,888 community-dwelling adults. PARTICIPANTS: Two hundred fifty-four adults aged 65 and older (mean age 78.6) who sustained a nonfatal first ischemic stroke. MEASUREMENTS: BP levels assessed at prestroke and poststroke CHS visits were examined as predictors of stroke recurrence, coronary heart disease (CHD), combined vascular events (CVEs), and mortality. RESULTS: Higher poststroke BP level, assessed 261.6 days (mean) after stroke, was associated with higher risk of stroke recurrence over 5.4 years (mean) of follow-up. The multivariate-adjusted hazard ratio for stroke recurrence was 1.42 (95% confidence interval (CI)=1.03-1.99) per standard deviation (SD) of systolic BP (P=.04) and 1.39 (95% CI=1.01-1.91) per SD of diastolic BP (P=.04). Mortality was significantly greater in patients with low or high poststroke BP than in those with intermediate BP. Poststroke BP was not associated with risk of CHD or CVE, although further analyses suggested that high systolic BP predicted CHD and CVE in younger but not older subjects. Prestroke BP did not predict poststroke outcomes. CONCLUSION: In this observational study of adults aged 65 and older assessed approximately 8 months after stroke, low BP was associated with favorable risk of recurrent stroke, although high and low poststroke BP levels were associated with greater mortality. Long-term antihypertensive trials in older stroke survivors would increase knowledge about the benefits of lowering BP in this population.

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KW - Prognosis

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