Relation between blood pressure and clinical outcome in hypertensive subjects with previous stroke

Background--This study investigated whether a mean blood pressure (BP) of < 130/80 mm Hg is associated with further reduction in cardiovascular outcomes in treated hypertensive subjects with previous stroke. Methods and Results--Subjects from the Korea National Health Insurance Service health examinee cohort diagnosed as having stroke and hypertension from January 1st, 2003 and December 31st, 2006 (N=2320) were grouped according to mean systolic ( < 130, 130- < 140, and ≥140 mm Hg) and diastolic ( < 80, 80- < 90, and ≥90 mm Hg) BP recorded during follow-up health examinations. All-cause and cardiovascular mortality over 11 years were compared. Compared with subjects with a systolic BP of ≥140 mm Hg (N=736), subjects with a systolic BP of 130 to < 140 mm Hg (N=793) had a significantly lower risk of all-cause death (hazard ratio [HR], 0.61; 95% confidence interval [CI], 0.47-0.79; P < 0.001), cardiovascular mortality (HR, 0.39; 95% CI, 0.25-0.61; P < 0.001), and fatal ischemic stroke (HR, 0.25; 95% CI, 0.10-0.63; P=0.003). Systolic BP of < 130 mm Hg (N=791) was associated with lower risk of nonfatal hemorrhagic stroke. Subjects with a diastolic BP of 80 to < 90 mm Hg (N=1100) had significantly lower risk of all-cause death (HR, 0.60, 95% CI, 0.45-0.80; P < 0.001) and cardiovascular mortality (HR, 0.45; 95% CI, 0.30-0.70; P < 0.001) than those with a diastolic BP of ≥90 mm Hg (N=342). Diastolic BP of < 80 mm Hg (N=878) was associated with reduced risk of nonfatal hemorrhagic stroke and further lowering of all-cause mortality and cardiovascular mortality. Conclusions--BP of < 130/80 mm Hg was associated with improved outcomes in hypertensive subjects with previous stroke.