Low Blood Pressure, Comorbidities, and Ischemic Stroke Mortality in US Veterans

Low blood pressure (BP) is associated with higher stroke mortality, although the factors underlying this association have not been fully explored. We investigated prestroke BP and long-term mortality after ischemic stroke in a national sample of US veterans. Using a retrospective cohort study design...

Full description

Saved in:
Bibliographic Details
Published in:Stroke (1970) 2022-03, Vol.53 (3), p.886-894
Main Authors: Aparicio, Hugo J., Tarko, Laura M., Gagnon, David, Costa, Lauren, Galloway, Ashley, Demissie, Serkalem, Djousse, Luc, Seshadri, Sudha, Cho, Kelly, Wilson, Peter W.F.
Format: Article
Language:English
Subjects:
Aged
Comorbidity
Female
Humans
Hypotension - mortality
Hypotension - physiopathology
Ischemic Stroke - mortality
Ischemic Stroke - physiopathology
Male
Middle Aged
Retrospective Studies
United States
Veterans
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
cited_by cdi_FETCH-LOGICAL-c4531-ab2969d4fb0754e163049d350f338da4b3dfe49e0b0a5603b50cd8a1db312c223
cites cdi_FETCH-LOGICAL-c4531-ab2969d4fb0754e163049d350f338da4b3dfe49e0b0a5603b50cd8a1db312c223
container_end_page 894
container_issue 3
container_start_page 886
container_title Stroke (1970)
container_volume 53
creator Aparicio, Hugo J.
Tarko, Laura M.
Gagnon, David
Costa, Lauren
Galloway, Ashley
Demissie, Serkalem
Djousse, Luc
Seshadri, Sudha
Cho, Kelly
Wilson, Peter W.F.
description Low blood pressure (BP) is associated with higher stroke mortality, although the factors underlying this association have not been fully explored. We investigated prestroke BP and long-term mortality after ischemic stroke in a national sample of US veterans. Using a retrospective cohort study design of veterans hospitalized between 2002 and 2007 with a first ischemic stroke and with ≥1 outpatient BP measurements 1 to 18 months before admission, we defined 6 categories each of average prestroke systolic BP (SBP) and diastolic BP, and 7 categories of pulse pressure. Patients were followed-up to 12 years for primary outcomes of all-cause and cardiovascular mortality. We used Cox models to relate prestroke BP indices to mortality and stratified analyses by the presence of preexisting comorbidities (smoking, myocardial infarction, heart failure, atrial fibrillation/flutter, cancer, and dementia), race and ethnicity. Of 29 690 eligible veterans with stroke (mean±SD age 67±12 years, 98% men, 67% White), 2989 (10%) had average prestroke SBP
doi_str_mv 10.1161/STROKEAHA.120.033195
format article
fullrecord <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8885902</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2593043317</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4531-ab2969d4fb0754e163049d350f338da4b3dfe49e0b0a5603b50cd8a1db312c223</originalsourceid><addsrcrecordid>eNpVkU1v1DAQhi0EapfSf4CQjxyaZfyVxBek7arQikWL2Jar5cQT1jSJi52w6r8n1ZYtPYxGo5l5Z_Q-hLxlMGcsZx8219_XXy4Wl4s54zAHIZhWL8iMKS4zmfPyJZkBCJ1xqfUxeZ3SLwDgolRH5FjIgheFhBlZr8KOnrchOPotYkpjxDO6DF2IlXd-8JjOqO0dvUr1Fjtf080Qwy3SryEOtvXDPfU9vdnQHzhgtH16Q141tk14-phPyM2ni-vlZbZaf75aLlZZLZVgma24zrWTTQWFkshyAVI7oaARonRWVsI1KDVCBVblICoFtSstc5VgvOZcnJCPe927serQ1dgP0bbmLvrOxnsTrDfPO73fmp_hjynLUml4EHj_KBDD7xHTYDqfamxb22MYk-FKTz9NrhbTqNyP1jGkFLE5nGFgHliYAwszsTB7FtPau_9fPCz9M_9Jdxfayb102447jGaLth22ZqIFRV5AxoFzEFOVTSGY-As_n5Wd</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2593043317</pqid></control><display><type>article</type><title>Low Blood Pressure, Comorbidities, and Ischemic Stroke Mortality in US Veterans</title><source>Alma/SFX Local Collection</source><creator>Aparicio, Hugo J. ; Tarko, Laura M. ; Gagnon, David ; Costa, Lauren ; Galloway, Ashley ; Demissie, Serkalem ; Djousse, Luc ; Seshadri, Sudha ; Cho, Kelly ; Wilson, Peter W.F.</creator><creatorcontrib>Aparicio, Hugo J. ; Tarko, Laura M. ; Gagnon, David ; Costa, Lauren ; Galloway, Ashley ; Demissie, Serkalem ; Djousse, Luc ; Seshadri, Sudha ; Cho, Kelly ; Wilson, Peter W.F.</creatorcontrib><description>Low blood pressure (BP) is associated with higher stroke mortality, although the factors underlying this association have not been fully explored. We investigated prestroke BP and long-term mortality after ischemic stroke in a national sample of US veterans. Using a retrospective cohort study design of veterans hospitalized between 2002 and 2007 with a first ischemic stroke and with ≥1 outpatient BP measurements 1 to 18 months before admission, we defined 6 categories each of average prestroke systolic BP (SBP) and diastolic BP, and 7 categories of pulse pressure. Patients were followed-up to 12 years for primary outcomes of all-cause and cardiovascular mortality. We used Cox models to relate prestroke BP indices to mortality and stratified analyses by the presence of preexisting comorbidities (smoking, myocardial infarction, heart failure, atrial fibrillation/flutter, cancer, and dementia), race and ethnicity. Of 29 690 eligible veterans with stroke (mean±SD age 67±12 years, 98% men, 67% White), 2989 (10%) had average prestroke SBP&lt;120 mm Hg. During a follow-up of 4.1±3.3 years, patients with SBP&lt;120 mm Hg experienced 61% all-cause and 27% cardiovascular mortality. In multivariable analyses, patients with the lowest SBP, lowest diastolic BP, and highest pulse pressure had the highest mortality risk: SBP&lt;120 versus 130 to 139 mm Hg (hazard ratio=1.26 [95% CI, 1.19-1.34]); diastolic BP &lt;60 versus 70 to 79 mm Hg (hazard ratio=1.35 [95% CI, 1.23-1.49]); and pulse pressure ≥90 versus 60 to 69 mm Hg (hazard ratio=1.24 [95% CI, 1.15-1.35]). Patients with average SBP&lt;120 mm Hg and at least one comorbidity (smoking, heart disease, cancer, or dementia) had the highest mortality risk (hazard ratio=1.45 [95% CI, 1.37-1.53]). Compared with normotension, low prestroke BP was associated with mortality after stroke, particularly among patients with at least one comorbidity.</description><identifier>ISSN: 0039-2499</identifier><identifier>ISSN: 1524-4628</identifier><identifier>EISSN: 1524-4628</identifier><identifier>DOI: 10.1161/STROKEAHA.120.033195</identifier><identifier>PMID: 34727740</identifier><language>eng</language><publisher>United States: Lippincott Williams &amp; Wilkins</publisher><subject>Aged ; Comorbidity ; Female ; Humans ; Hypotension - mortality ; Hypotension - physiopathology ; Ischemic Stroke - mortality ; Ischemic Stroke - physiopathology ; Male ; Middle Aged ; Retrospective Studies ; United States ; Veterans</subject><ispartof>Stroke (1970), 2022-03, Vol.53 (3), p.886-894</ispartof><rights>Lippincott Williams &amp; Wilkins</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4531-ab2969d4fb0754e163049d350f338da4b3dfe49e0b0a5603b50cd8a1db312c223</citedby><cites>FETCH-LOGICAL-c4531-ab2969d4fb0754e163049d350f338da4b3dfe49e0b0a5603b50cd8a1db312c223</cites><orcidid>0000-0001-8584-1455 ; 0000-0002-9902-3047 ; 0000-0002-5653-7056 ; 0000-0002-6367-3179</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34727740$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Aparicio, Hugo J.</creatorcontrib><creatorcontrib>Tarko, Laura M.</creatorcontrib><creatorcontrib>Gagnon, David</creatorcontrib><creatorcontrib>Costa, Lauren</creatorcontrib><creatorcontrib>Galloway, Ashley</creatorcontrib><creatorcontrib>Demissie, Serkalem</creatorcontrib><creatorcontrib>Djousse, Luc</creatorcontrib><creatorcontrib>Seshadri, Sudha</creatorcontrib><creatorcontrib>Cho, Kelly</creatorcontrib><creatorcontrib>Wilson, Peter W.F.</creatorcontrib><title>Low Blood Pressure, Comorbidities, and Ischemic Stroke Mortality in US Veterans</title><title>Stroke (1970)</title><addtitle>Stroke</addtitle><description>Low blood pressure (BP) is associated with higher stroke mortality, although the factors underlying this association have not been fully explored. We investigated prestroke BP and long-term mortality after ischemic stroke in a national sample of US veterans. Using a retrospective cohort study design of veterans hospitalized between 2002 and 2007 with a first ischemic stroke and with ≥1 outpatient BP measurements 1 to 18 months before admission, we defined 6 categories each of average prestroke systolic BP (SBP) and diastolic BP, and 7 categories of pulse pressure. Patients were followed-up to 12 years for primary outcomes of all-cause and cardiovascular mortality. We used Cox models to relate prestroke BP indices to mortality and stratified analyses by the presence of preexisting comorbidities (smoking, myocardial infarction, heart failure, atrial fibrillation/flutter, cancer, and dementia), race and ethnicity. Of 29 690 eligible veterans with stroke (mean±SD age 67±12 years, 98% men, 67% White), 2989 (10%) had average prestroke SBP&lt;120 mm Hg. During a follow-up of 4.1±3.3 years, patients with SBP&lt;120 mm Hg experienced 61% all-cause and 27% cardiovascular mortality. In multivariable analyses, patients with the lowest SBP, lowest diastolic BP, and highest pulse pressure had the highest mortality risk: SBP&lt;120 versus 130 to 139 mm Hg (hazard ratio=1.26 [95% CI, 1.19-1.34]); diastolic BP &lt;60 versus 70 to 79 mm Hg (hazard ratio=1.35 [95% CI, 1.23-1.49]); and pulse pressure ≥90 versus 60 to 69 mm Hg (hazard ratio=1.24 [95% CI, 1.15-1.35]). Patients with average SBP&lt;120 mm Hg and at least one comorbidity (smoking, heart disease, cancer, or dementia) had the highest mortality risk (hazard ratio=1.45 [95% CI, 1.37-1.53]). Compared with normotension, low prestroke BP was associated with mortality after stroke, particularly among patients with at least one comorbidity.</description><subject>Aged</subject><subject>Comorbidity</subject><subject>Female</subject><subject>Humans</subject><subject>Hypotension - mortality</subject><subject>Hypotension - physiopathology</subject><subject>Ischemic Stroke - mortality</subject><subject>Ischemic Stroke - physiopathology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Retrospective Studies</subject><subject>United States</subject><subject>Veterans</subject><issn>0039-2499</issn><issn>1524-4628</issn><issn>1524-4628</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNpVkU1v1DAQhi0EapfSf4CQjxyaZfyVxBek7arQikWL2Jar5cQT1jSJi52w6r8n1ZYtPYxGo5l5Z_Q-hLxlMGcsZx8219_XXy4Wl4s54zAHIZhWL8iMKS4zmfPyJZkBCJ1xqfUxeZ3SLwDgolRH5FjIgheFhBlZr8KOnrchOPotYkpjxDO6DF2IlXd-8JjOqO0dvUr1Fjtf080Qwy3SryEOtvXDPfU9vdnQHzhgtH16Q141tk14-phPyM2ni-vlZbZaf75aLlZZLZVgma24zrWTTQWFkshyAVI7oaARonRWVsI1KDVCBVblICoFtSstc5VgvOZcnJCPe927serQ1dgP0bbmLvrOxnsTrDfPO73fmp_hjynLUml4EHj_KBDD7xHTYDqfamxb22MYk-FKTz9NrhbTqNyP1jGkFLE5nGFgHliYAwszsTB7FtPau_9fPCz9M_9Jdxfayb102447jGaLth22ZqIFRV5AxoFzEFOVTSGY-As_n5Wd</recordid><startdate>20220301</startdate><enddate>20220301</enddate><creator>Aparicio, Hugo J.</creator><creator>Tarko, Laura M.</creator><creator>Gagnon, David</creator><creator>Costa, Lauren</creator><creator>Galloway, Ashley</creator><creator>Demissie, Serkalem</creator><creator>Djousse, Luc</creator><creator>Seshadri, Sudha</creator><creator>Cho, Kelly</creator><creator>Wilson, Peter W.F.</creator><general>Lippincott Williams &amp; Wilkins</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-8584-1455</orcidid><orcidid>https://orcid.org/0000-0002-9902-3047</orcidid><orcidid>https://orcid.org/0000-0002-5653-7056</orcidid><orcidid>https://orcid.org/0000-0002-6367-3179</orcidid></search><sort><creationdate>20220301</creationdate><title>Low Blood Pressure, Comorbidities, and Ischemic Stroke Mortality in US Veterans</title><author>Aparicio, Hugo J. ; Tarko, Laura M. ; Gagnon, David ; Costa, Lauren ; Galloway, Ashley ; Demissie, Serkalem ; Djousse, Luc ; Seshadri, Sudha ; Cho, Kelly ; Wilson, Peter W.F.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4531-ab2969d4fb0754e163049d350f338da4b3dfe49e0b0a5603b50cd8a1db312c223</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Aged</topic><topic>Comorbidity</topic><topic>Female</topic><topic>Humans</topic><topic>Hypotension - mortality</topic><topic>Hypotension - physiopathology</topic><topic>Ischemic Stroke - mortality</topic><topic>Ischemic Stroke - physiopathology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Retrospective Studies</topic><topic>United States</topic><topic>Veterans</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Aparicio, Hugo J.</creatorcontrib><creatorcontrib>Tarko, Laura M.</creatorcontrib><creatorcontrib>Gagnon, David</creatorcontrib><creatorcontrib>Costa, Lauren</creatorcontrib><creatorcontrib>Galloway, Ashley</creatorcontrib><creatorcontrib>Demissie, Serkalem</creatorcontrib><creatorcontrib>Djousse, Luc</creatorcontrib><creatorcontrib>Seshadri, Sudha</creatorcontrib><creatorcontrib>Cho, Kelly</creatorcontrib><creatorcontrib>Wilson, Peter W.F.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Stroke (1970)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Aparicio, Hugo J.</au><au>Tarko, Laura M.</au><au>Gagnon, David</au><au>Costa, Lauren</au><au>Galloway, Ashley</au><au>Demissie, Serkalem</au><au>Djousse, Luc</au><au>Seshadri, Sudha</au><au>Cho, Kelly</au><au>Wilson, Peter W.F.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Low Blood Pressure, Comorbidities, and Ischemic Stroke Mortality in US Veterans</atitle><jtitle>Stroke (1970)</jtitle><addtitle>Stroke</addtitle><date>2022-03-01</date><risdate>2022</risdate><volume>53</volume><issue>3</issue><spage>886</spage><epage>894</epage><pages>886-894</pages><issn>0039-2499</issn><issn>1524-4628</issn><eissn>1524-4628</eissn><abstract>Low blood pressure (BP) is associated with higher stroke mortality, although the factors underlying this association have not been fully explored. We investigated prestroke BP and long-term mortality after ischemic stroke in a national sample of US veterans. Using a retrospective cohort study design of veterans hospitalized between 2002 and 2007 with a first ischemic stroke and with ≥1 outpatient BP measurements 1 to 18 months before admission, we defined 6 categories each of average prestroke systolic BP (SBP) and diastolic BP, and 7 categories of pulse pressure. Patients were followed-up to 12 years for primary outcomes of all-cause and cardiovascular mortality. We used Cox models to relate prestroke BP indices to mortality and stratified analyses by the presence of preexisting comorbidities (smoking, myocardial infarction, heart failure, atrial fibrillation/flutter, cancer, and dementia), race and ethnicity. Of 29 690 eligible veterans with stroke (mean±SD age 67±12 years, 98% men, 67% White), 2989 (10%) had average prestroke SBP&lt;120 mm Hg. During a follow-up of 4.1±3.3 years, patients with SBP&lt;120 mm Hg experienced 61% all-cause and 27% cardiovascular mortality. In multivariable analyses, patients with the lowest SBP, lowest diastolic BP, and highest pulse pressure had the highest mortality risk: SBP&lt;120 versus 130 to 139 mm Hg (hazard ratio=1.26 [95% CI, 1.19-1.34]); diastolic BP &lt;60 versus 70 to 79 mm Hg (hazard ratio=1.35 [95% CI, 1.23-1.49]); and pulse pressure ≥90 versus 60 to 69 mm Hg (hazard ratio=1.24 [95% CI, 1.15-1.35]). Patients with average SBP&lt;120 mm Hg and at least one comorbidity (smoking, heart disease, cancer, or dementia) had the highest mortality risk (hazard ratio=1.45 [95% CI, 1.37-1.53]). Compared with normotension, low prestroke BP was associated with mortality after stroke, particularly among patients with at least one comorbidity.</abstract><cop>United States</cop><pub>Lippincott Williams &amp; Wilkins</pub><pmid>34727740</pmid><doi>10.1161/STROKEAHA.120.033195</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-8584-1455</orcidid><orcidid>https://orcid.org/0000-0002-9902-3047</orcidid><orcidid>https://orcid.org/0000-0002-5653-7056</orcidid><orcidid>https://orcid.org/0000-0002-6367-3179</orcidid><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 0039-2499
ispartof Stroke (1970), 2022-03, Vol.53 (3), p.886-894
issn 0039-2499
1524-4628
1524-4628
language eng
recordid cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8885902
source Alma/SFX Local Collection
subjects Aged
Comorbidity
Female
Humans
Hypotension - mortality
Hypotension - physiopathology
Ischemic Stroke - mortality
Ischemic Stroke - physiopathology
Male
Middle Aged
Retrospective Studies
United States
Veterans
title Low Blood Pressure, Comorbidities, and Ischemic Stroke Mortality in US Veterans
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-24T16%3A52%3A41IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Low%20Blood%20Pressure,%20Comorbidities,%20and%20Ischemic%20Stroke%20Mortality%20in%20US%20Veterans&rft.jtitle=Stroke%20(1970)&rft.au=Aparicio,%20Hugo%20J.&rft.date=2022-03-01&rft.volume=53&rft.issue=3&rft.spage=886&rft.epage=894&rft.pages=886-894&rft.issn=0039-2499&rft.eissn=1524-4628&rft_id=info:doi/10.1161/STROKEAHA.120.033195&rft_dat=%3Cproquest_pubme%3E2593043317%3C/proquest_pubme%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c4531-ab2969d4fb0754e163049d350f338da4b3dfe49e0b0a5603b50cd8a1db312c223%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2593043317&rft_id=info:pmid/34727740&rfr_iscdi=true