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Abstract
Objective: To investigate the association between blood pressure (BP) levels and risk of intracerebral hemorrhage (ICH) after ischemic stroke.
Methods: We performed a post hoc analysis of data from the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial, a randomized clinical trial including 20,332 patients with recent noncardioembolic ischemic stroke. BP measurements were divided into predefined categories. We calculated incidence rates per BP category and performed multivariable Cox regression analysis with systolic blood pressure (SBP) and diastolic blood pressure (DBP) categories as time-dependent covariables.
Results: One hundred thirty-three ICHs occurred during 50,778 person-years of follow-up, resulting in an incidence rate of 2.6 per 1,000 person-years. The incidence rate of ICH increased with increasing SBP and DBP categories. Risk of ICH was significantly higher in patients with SBP ≥160 mm Hg (hazard ratio 2.27, 95% confidence interval 1.34–3.86) compared with those with SBP of 130–<140 mm Hg and in patients with DBP ≥100 mm Hg (hazard ratio 3.08, 95% confidence interval 1.78–5.34) compared with those with DBP of 80–<90 mm Hg. The association between SBP or DBP and ICH did not differ by ischemic stroke subtype (p = 0.55 and 0.93).
Conclusions: Among patients with recent noncardioembolic ischemic stroke, the risk of ICH is high. High SBP and DBP are associated with an increased risk of ICH. The association between BP and ICH is not dependent on ischemic stroke subtype.
GLOSSARY
- BP=
- blood pressure;
- CI=
- confidence interval;
- DBP=
- diastolic blood pressure;
- HR=
- hazard ratio;
- ICH=
- intracerebral hemorrhage;
- PRoFESS=
- Prevention Regimen for Effectively Avoiding Second Strokes;
- PROGRESS=
- Perindopril Protection Against Recurrent Stroke Study;
- SBP=
- systolic blood pressure;
- SPS3=
- Secondary Prevention of Small Subcortical Strokes;
- TRIDENT=
- Triple Therapy Prevention of Recurrent Intracerebral Disease Events Trial
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at Neurology.org
- Received June 22, 2016.
- Accepted in final form October 4, 2016.
- © 2016 American Academy of Neurology
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