Blood Pressure Variability and Cardiovascular Outcomes in Patients With Prior Stroke: A Secondary Analysis of PRoFESS

• Published in: Stroke (1970) 2019-11, Vol.50 (11), p.3170-3176
• Main Authors: de Havenon, Adam, Fino, Nora F, Johnson, Brian, Wong, Ka-Ho, Majersik, Jennifer J, Tirschwell, David, Rost, Natalia
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Blood Pressure; Female; Heart Failure - etiology; Heart Failure - mortality; Heart Failure - physiopathology; Heart Failure - prevention & control; Humans; Hypertension - complications; Hypertension - drug therapy; Hypertension - mortality; Hypertension - physiopathology; Intracranial Hemorrhages - etiology; Intracranial Hemorrhages - mortality; Intracranial Hemorrhages - physiopathology; Intracranial Hemorrhages - prevention & control; Male; Middle Aged; Myocardial Infarction - etiology; Myocardial Infarction - mortality; Myocardial Infarction - physiopathology; Myocardial Infarction - prevention & control; Risk Factors; Stroke - etiology; Stroke - mortality; Stroke - physiopathology; Stroke - prevention & control
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/STROKEAHA.119.026293

BACKGROUND AND PURPOSE—Every year in the United States, almost 185 000 ischemic strokes occur in patients with a prior stroke. Recurrent stroke has significantly higher morbidity and mortality. Among modifiable risk factors for recurrent stroke, hypertension is the most prevalent. Reducing systolic blood pressure is standard of care for secondary stroke prevention. Recent literature suggests that increased blood pressure variability (BPV) is associated with primary stroke, although studies have not convincingly shown that it is associated with recurrent stroke, which was the goal of this analysis. METHODS—We conducted a secondary analysis of 17 916 patients in the PRoFESS (Prevention Regimen for Effectively Avoiding Second Strokes) trial, which is the largest trial of patients with potential recurrent stroke. We calculated BPV and evaluated its effect on recurrent stroke (composite and stratified by ischemic or hemorrhagic stroke), major cardiovascular events (death from cardiovascular causes, recurrent stroke, myocardial infarction, or new or worsening heart failure), and all-cause death. RESULTS—Both systolic and diastolic BPV were associated with recurrent stroke, major cardiovascular events, and all-cause death. The association with stroke was significant for ischemic, but not hemorrhagic, stroke. For every 10-point increase in BPV (systolic SD, range =0–54.2), the hazard ratio for a recurrent ischemic stroke was 1.15 (95% CI, 1.02–1.32; P=0.02), for major cardiovascular events was 1.19 (95% CI, 1.09–1.31; P