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.