One‐Year Blood Pressure Trajectory After Acute Ischemic Stroke
Background Although the effect of blood pressure on poststroke outcome is well recognized, the long‐term trajectory of blood pressure after acute ischemic stroke and its influence on outcomes have not been studied well. Methods and Results We analyzed systolic blood pressure (SBP) measurements in 55...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2022-03-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.121.023747 |
| _version_ | 1827907383377002496 |
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| author | Keon‐Joo Lee Beom Joon Kim Moon‐Ku Han Joon‐Tae Kim Kang Ho Choi Dong‐Ick Shin Jae‐Kwan Cha Dae‐Hyun Kim Dong‐Eog Kim Wi‐Sun Ryu Jong‐Moo Park Kyusik Kang Soo Joo Lee Mi‐Sun Oh Kyung‐Ho Yu Byung‐Chul Lee Keun‐Sik Hong Yong‐Jin Cho Jay Chol Choi Tai Hwan Park Sang‐Soon Park Jee‐Hyun Kwon Wook‐Joo Kim Jun Lee Sung Il Sohn Jeong‐Ho Hong Kyung Bok Lee Ji Sung Lee Juneyoung Lee Philip B. Gorelick Hee‐Joon Bae |
| author_facet | Keon‐Joo Lee Beom Joon Kim Moon‐Ku Han Joon‐Tae Kim Kang Ho Choi Dong‐Ick Shin Jae‐Kwan Cha Dae‐Hyun Kim Dong‐Eog Kim Wi‐Sun Ryu Jong‐Moo Park Kyusik Kang Soo Joo Lee Mi‐Sun Oh Kyung‐Ho Yu Byung‐Chul Lee Keun‐Sik Hong Yong‐Jin Cho Jay Chol Choi Tai Hwan Park Sang‐Soon Park Jee‐Hyun Kwon Wook‐Joo Kim Jun Lee Sung Il Sohn Jeong‐Ho Hong Kyung Bok Lee Ji Sung Lee Juneyoung Lee Philip B. Gorelick Hee‐Joon Bae |
| author_sort | Keon‐Joo Lee |
| collection | DOAJ |
| description | Background Although the effect of blood pressure on poststroke outcome is well recognized, the long‐term trajectory of blood pressure after acute ischemic stroke and its influence on outcomes have not been studied well. Methods and Results We analyzed systolic blood pressure (SBP) measurements in 5514 patients with acute ischemic stroke at ≥2 of 7 prespecified time points during the first year after stroke among those enrolled in a multicenter prospective registry. Longitudinal SBPs were categorized using a group‐based trajectory model. The primary outcome was a composite of stroke recurrence, myocardial infarction, and all‐cause mortality up to 1 year after stroke. The study subjects were categorized into 4 SBP trajectory groups: low (27.0%), moderate (59.5%), persistently high (1.2%), and slowly dropping (12.4%). In the first 3 groups, SBP decreased during the first 3 to 7 days and remained steady thereafter. In the slowly dropping SBP group, SBPs decreased from 182 to 135 mm Hg during the first 30 days, then paralleled the trajectory of the moderate SBP group. Compared with the reference, the moderate SBP group, the slowly dropping SBP group was at higher risk for the primary outcome (adjusted hazard ratio [HR], 1.32; 95% CI, 1.05‒1.65) and mortality (adjusted HR, 1.35; 95% CI, 1.03‒1.78). Primary outcome rates were similarly high in the persistently high SBP group. Conclusions Four 1‐year longitudinal SBP trajectories were identified in patients with acute ischemic stroke. Patients in the slowly dropping SBP and persistently high SBP trajectory groups were prone to adverse cardiovascular outcomes after stroke. |
| first_indexed | 2024-03-13T01:08:15Z |
| format | Article |
| id | doaj.art-dcc9fac392fb47e9b3b9c441f57b440b |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-13T01:08:15Z |
| publishDate | 2022-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-dcc9fac392fb47e9b3b9c441f57b440b2023-07-06T05:53:20ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802022-03-0111510.1161/JAHA.121.023747One‐Year Blood Pressure Trajectory After Acute Ischemic StrokeKeon‐Joo Lee0Beom Joon Kim1Moon‐Ku Han2Joon‐Tae Kim3Kang Ho Choi4Dong‐Ick Shin5Jae‐Kwan Cha6Dae‐Hyun Kim7Dong‐Eog Kim8Wi‐Sun Ryu9Jong‐Moo Park10Kyusik Kang11Soo Joo Lee12Mi‐Sun Oh13Kyung‐Ho Yu14Byung‐Chul Lee15Keun‐Sik Hong16Yong‐Jin Cho17Jay Chol Choi18Tai Hwan Park19Sang‐Soon Park20Jee‐Hyun Kwon21Wook‐Joo Kim22Jun Lee23Sung Il Sohn24Jeong‐Ho Hong25Kyung Bok Lee26Ji Sung Lee27Juneyoung Lee28Philip B. Gorelick29Hee‐Joon Bae30Department of Neurology Seoul National University Bundang Hospital Seongnam KoreaDepartment of Neurology Seoul National University Bundang Hospital Seongnam KoreaDepartment of Neurology Seoul National University Bundang Hospital Seongnam KoreaDepartment of Neurology Chonnam National University Hospital Gwangju KoreaDepartment of Neurology Chonnam National University Hospital Gwangju KoreaDepartment of Neurology Chungbuk National University Hospital Cheongju KoreaDepartment of Neurology Dong‐A University Hospital Busan KoreaDepartment of Neurology Dong‐A University Hospital Busan KoreaDepartment of Neurology Dongguk University Ilsan Hospital Goyang KoreaDepartment of Neurology Dongguk University Ilsan Hospital Goyang KoreaDepartment of Neurology Uijeongbu Eulji Medical CenterEulji University Seoul KoreaDepartment of Neurology Nowon Eulji Medical CenterEulji University Seoul KoreaDepartment of Neurology Eulji University Hospital Daejeon KoreaDepartment of Neurology Hallym University Sacred Heart Hospital Anyang KoreaDepartment of Neurology Hallym University Sacred Heart Hospital Anyang KoreaDepartment of Neurology Hallym University Sacred Heart Hospital Anyang KoreaDepartment of Neurology Inje University Ilsan Paik Hospital Goyang KoreaDepartment of Neurology Inje University Ilsan Paik Hospital Goyang KoreaDepartment of Neurology Jeju National University Hospital Jeju KoreaDepartment of Neurology Seoul Medical Center Seoul KoreaDepartment of Neurology Seoul Medical Center Seoul KoreaDepartment of Neurology Ulsan University Hospital Ulsan University College of Medicine Ulsan KoreaDepartment of Neurology Ulsan University Hospital Ulsan University College of Medicine Ulsan KoreaDepartment of Neurology Yeungnam University Medical Center Daegu KoreaDepartment of Neurology Keimyung University Dongsan Medical Center Daegu KoreaDepartment of Neurology Keimyung University Dongsan Medical Center Daegu KoreaDepartment of Neurology Soonchunhyang University Hospital Seoul KoreaClinical Research Center Asan Medical Center Seoul KoreaDepartment of Biostatistics Korea University Seoul KoreaDavee Department of Neurology Feinberg School of MedicineNorthwestern University Chicago ILDepartment of Neurology Seoul National University Bundang Hospital Seongnam KoreaBackground Although the effect of blood pressure on poststroke outcome is well recognized, the long‐term trajectory of blood pressure after acute ischemic stroke and its influence on outcomes have not been studied well. Methods and Results We analyzed systolic blood pressure (SBP) measurements in 5514 patients with acute ischemic stroke at ≥2 of 7 prespecified time points during the first year after stroke among those enrolled in a multicenter prospective registry. Longitudinal SBPs were categorized using a group‐based trajectory model. The primary outcome was a composite of stroke recurrence, myocardial infarction, and all‐cause mortality up to 1 year after stroke. The study subjects were categorized into 4 SBP trajectory groups: low (27.0%), moderate (59.5%), persistently high (1.2%), and slowly dropping (12.4%). In the first 3 groups, SBP decreased during the first 3 to 7 days and remained steady thereafter. In the slowly dropping SBP group, SBPs decreased from 182 to 135 mm Hg during the first 30 days, then paralleled the trajectory of the moderate SBP group. Compared with the reference, the moderate SBP group, the slowly dropping SBP group was at higher risk for the primary outcome (adjusted hazard ratio [HR], 1.32; 95% CI, 1.05‒1.65) and mortality (adjusted HR, 1.35; 95% CI, 1.03‒1.78). Primary outcome rates were similarly high in the persistently high SBP group. Conclusions Four 1‐year longitudinal SBP trajectories were identified in patients with acute ischemic stroke. Patients in the slowly dropping SBP and persistently high SBP trajectory groups were prone to adverse cardiovascular outcomes after stroke.https://www.ahajournals.org/doi/10.1161/JAHA.121.023747acute ischemic strokeblood pressurecohort studygroup‐based trajectory modelprognosis |
| spellingShingle | Keon‐Joo Lee Beom Joon Kim Moon‐Ku Han Joon‐Tae Kim Kang Ho Choi Dong‐Ick Shin Jae‐Kwan Cha Dae‐Hyun Kim Dong‐Eog Kim Wi‐Sun Ryu Jong‐Moo Park Kyusik Kang Soo Joo Lee Mi‐Sun Oh Kyung‐Ho Yu Byung‐Chul Lee Keun‐Sik Hong Yong‐Jin Cho Jay Chol Choi Tai Hwan Park Sang‐Soon Park Jee‐Hyun Kwon Wook‐Joo Kim Jun Lee Sung Il Sohn Jeong‐Ho Hong Kyung Bok Lee Ji Sung Lee Juneyoung Lee Philip B. Gorelick Hee‐Joon Bae One‐Year Blood Pressure Trajectory After Acute Ischemic Stroke Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease acute ischemic stroke blood pressure cohort study group‐based trajectory model prognosis |
| title | One‐Year Blood Pressure Trajectory After Acute Ischemic Stroke |
| title_full | One‐Year Blood Pressure Trajectory After Acute Ischemic Stroke |
| title_fullStr | One‐Year Blood Pressure Trajectory After Acute Ischemic Stroke |
| title_full_unstemmed | One‐Year Blood Pressure Trajectory After Acute Ischemic Stroke |
| title_short | One‐Year Blood Pressure Trajectory After Acute Ischemic Stroke |
| title_sort | one year blood pressure trajectory after acute ischemic stroke |
| topic | acute ischemic stroke blood pressure cohort study group‐based trajectory model prognosis |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.121.023747 |
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