Frontiers in Neurology (May 2020)

Effect of Low Diastolic Blood Pressure to Cardiovascular Risk in Patients With Ischemic Stroke or Transient Ischemic Attacks Under Different Systolic Blood Pressure Levels

  • Zimo Chen,
  • Zimo Chen,
  • Zimo Chen,
  • Zimo Chen,
  • Jinglin Mo,
  • Jinglin Mo,
  • Jinglin Mo,
  • Jinglin Mo,
  • Jie Xu,
  • Jie Xu,
  • Jie Xu,
  • Jie Xu,
  • Liye Dai,
  • Liye Dai,
  • Liye Dai,
  • Liye Dai,
  • Aichun Cheng,
  • Aichun Cheng,
  • Aichun Cheng,
  • Aichun Cheng,
  • Gulbahram Yalkun,
  • Gulbahram Yalkun,
  • Gulbahram Yalkun,
  • Gulbahram Yalkun,
  • Anxin Wang,
  • Anxin Wang,
  • Anxin Wang,
  • Anxin Wang,
  • Xia Meng,
  • Xia Meng,
  • Xia Meng,
  • Xia Meng,
  • Hao Li,
  • Hao Li,
  • Hao Li,
  • Hao Li,
  • Yongjun Wang,
  • Yongjun Wang,
  • Yongjun Wang,
  • Yongjun Wang

DOI
https://doi.org/10.3389/fneur.2020.00356
Journal volume & issue
Vol. 11

Abstract

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Background: In the context of recently updated strategies of pressure management, there is a paucity of evidence on the effect of diastolic blood pressure (DBP) level on adverse events among stroke patients. This study aimed to examine the effect of low DBP (<60 mmHg) under different levels of systolic blood pressure (SBP) on the risk of composite events and stroke recurrence among patients with ischemic stroke (IS) or transient ischemic attack (TIA).Material and Methods: This study was conducted in 2,325 patients with IS or TIA. DBP values were categorized into <60, 60–70, 70–80 (reference), 80–90, and ≥90 mmHg in the main sample and were further categorized as <60 and ≥60 mmHg (reference) when patients were stratified according to SBP levels (<140, <130, and <120 mmHg). The outcomes were defined as recurrent stroke and cumulative composite events (defined as the combination of nonfatal myocardial infarction, nonfatal congestive heart failure, and death) at 1 year.Results: During 1 year of follow-up, a total of 95 composite events and 138 stroke recurrences were identified. The patients with low DBP showed a significantly higher risk of composite events [hazard ratio (HR) = 4.86, 95% confidence interval (CI) = 2.54–8.52], especially the elderly patients (≥60 years); however, this result was not observed for stroke recurrence (HR = 0.90, 95% CI = 0.46–1.74). With the reduction of the SBP levels, the proportion of patients with low DBP increased (6.87, 12.67, and 34.46%), and the risk for composite events persisted.Conclusions: Along with the new target levels of SBP suggested by updated criteria, there is a trend for DBP to be reduced to a harmfully low level, which was associated with an increased risk of composite events among patients with IS or TIA.

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