Trajectory Groups of 24-Hour Systolic Blood Pressure After Acute Ischemic Stroke and Recurrent Vascular Events

Beom Joon Kim, Yong Jin Cho, Keun Sik Hong, Jun Lee, Joon Tae Kim, Kang Ho Choi, Tai Hwan Park, Sang Soon Park, Jong Moo Park, Kyusik Kang, Soo Joo Lee, Jae Guk Kim, Jae Kwan Cha, Dae Hyun Kim, Hyun Wook Nah, Byung Chul Lee, Kyung Ho Yu, Mi Sun Oh, Dong Eog Kim, Wi Sun RyuJay Chol Choi, Wook Joo Kim, Dong Ick Shin, Min Ju Yeo, Sung Il Sohn, Jeong Ho Hong, Ji Sung Lee, Juneyoung Lee, Moon Ku Han, Philip B. Gorelick, Hee Joon Bae

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)

Abstract

Background and Purpose- Blood pressure dynamics in patients with acute ischemic stroke may serve as an important modifiable and prognostic factor. Methods- A total of 8376 patients with acute ischemic stroke were studied from a prospective multicenter registry. Patients were eligible if they had been admitted within 24 hours of symptom onset and had ≥5 systolic blood pressure (SBP) measurements during the first 24 hours of hospitalization. SBP trajectory groups in the first 24 hours were identified using the TRAJ procedure in SAS software with delta-Bayesian Information Criterion and prespecified modeling parameters. Vascular events, including recurrent stroke, myocardial infarction, and death, were prospectively collected. The risk of having vascular events was calculated using the frailty model to adjust for clustering by hospital. Results- The group-based trajectory model classified patients with acute ischemic stroke into 5 SBP trajectory groups: low (22.3%), moderate (40.8%), rapidly stabilized (11.9%), acutely elevated (18.5%), and persistently high (6.4%) SBP. The risk of having vascular events was increased in the acutely elevated (hazard ratio, 1.28 [95% confidence interval, 1.12-1.47]) and the persistently high SBP groups (hazard ratio, 1.67 [95% confidence interval, 1.37-2.04]) but not in the rapidly stabilized group (hazard ratio, 1.13 [95% confidence interval, 0.95-1.34]), when compared with the moderate SBP group. Conclusions- SBP during the first 24 hours after acute ischemic stroke may be categorized into distinct trajectory groups, which differ in relation to stroke characteristics and frequency of subsequent recurrent vascular event risks. The findings may help to recognize potential candidates for future blood pressure control trials.

Original languageEnglish
Pages (from-to)1836-1842
Number of pages7
JournalStroke
Volume49
Issue number8
DOIs
Publication statusPublished - 2018 Aug 1

Keywords

  • blood pressure
  • brain ischemia
  • death
  • humans
  • stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialised Nursing

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