One-Year Blood Pressure Trajectory After Acute Ischemic Stroke

Background Although the effect of blood pressure on poststroke outcome is well recognized, the long-term trajectory of blood pressure after acute ischemic stroke and its influence on outcomes have not been studied well. Methods and Results We analyzed systolic blood pressure (SBP) measurements in 5514 patients with acute ischemic stroke at ≥2 of 7 prespecified time points during the first year after stroke among those enrolled in a multicenter prospective registry. Longitudinal SBPs were categorized using a group-based trajectory model. The primary outcome was a composite of stroke recurrence, myocardial infarction, and all-cause mortality up to 1 year after stroke. The study subjects were categorized into 4 SBP trajectory groups: (27.0%), (59.5%), (1.2%), and (12.4%). In the first 3 groups, SBP decreased during the first 3 to 7 days and remained steady thereafter. In the , SBPs decreased from 182 to 135 mm Hg during the first 30 days, then paralleled the trajectory of the . Compared with the reference, the , the was at higher risk for the primary outcome (adjusted hazard ratio [HR], 1.32; 95% CI, 1.05‒1.65) and mortality (adjusted HR, 1.35; 95% CI, 1.03‒1.78). Primary outcome rates were similarly high in the . Conclusions Four 1-year longitudinal SBP trajectories were identified in patients with acute ischemic stroke. Patients in the and trajectory groups were prone to adverse cardiovascular outcomes after stroke.