Post‐stroke diastolic blood pressure and risk of recurrent vascular events

Background and purpose Recent clinical trials and expert consensus guidelines have typically focused on the issue of systolic blood pressure ( SBP ) targets for reducing vascular risk. However, little is known about the relationship of the diastolic BP ( DBP ) level with vascular outcomes after a stroke. Methods A multicenter trial dataset involving 3680 recent (<4 months) non‐cardioembolic stroke patients followed for 2 years was analyzed. Subjects were categorized per mean DBP level (mmHg) during follow‐up: low−normal (<70), normal (70 to <80), high−normal (80–89) and high (≥90). Pulse pressure ( PP ) was prespecified by three categories of <60, 60 to <70, and ≥70 mmHg. Independent associations of mean DBP level with major vascular events ( MVE s) and ischaemic stroke were assessed. Results Major vascular events occurred in 20.7% of the low−normal, 15.1% of the normal, 16.9% of the high−normal and 19.2% of the high DBP groups, whilst stroke occurred in 9.9%, 6.8%, 8.5% and 10.8%, respectively. Compared with the normal DBP group, risk of MVE s was higher in the low−normal DBP group (adjusted hazard ratio 1.33; 95% confidence interval 1.04–1.71). Amongst those with SBP 120 to <140 mmHg, risk of MVE s (1.89; 1.13–3.15) and stroke (2.87; 1.48–5.53) was higher in subjects with PP ≥70 (mean DBP 62.4 ± 3.8) than those with the lowest PP (mean DBP 78.0 ± 5.9) whilst, amongst those with SBP <120 mmHg, PP 60 to <70 (mean DBP 52.7 ± 2.5) was associated with increased risk of stroke (5.85; 1.25–27.5). Conclusion Diastolic BP levels in the low−normal range, particularly accompanied by an increased PP of >60, confer increased risk of MVE s and stroke amongst patients after recent non‐cardioembolic stroke.