OS 31-05 THE IMPORTANCE OF INTER-INDIVIDUAL BLOOD PRESSURE VARIABILITY ON THE INCIDENCE OF RECURRENT STROKE: A POST HOC ANALYSIS OF ASCOT AND ALLHAT


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Abstract

Objective:To evaluate differences in blood pressure variability (BPV) between patients who experience a recurrent (secondary) stroke or transient ischemic attack (TIA) compared with patients who do not have recurrent stroke.Design and Method:Data were extracted from the ALLHAT and ASCOT-BPLA databases. BPV was defined as the within-subject standard deviation of systolic BP measurements across visits from 12-weeks (or 3-months [84 days]) onwards. BPV was analyzed using a generalized linear model with terms for treatment, prior stroke, interaction between treatment group and prior stroke, and baseline systolic BP. Incidence of recurrent stroke was analyzed using a Chi-square test.Results:For ASCOT-BPLA, BPV was significantly higher for patients who did (N = 2046) vs. those who did not (N = 16,806) have a prior stroke, within both the amlodipine and atenolol arms (P < 0.01 for both). Of the 2046 patients from ASCOT-BPLA who had a prior stroke/TIA, 252 (12.3%) had a recurrent stroke/TIA. When patients with prior stroke/TIA were analyzed by BPV quartiles, those with high (≥ Q3) vs. low (P = 0.0068). Of the 2,173 patients from ALLHAT with prior stroke, 161 (7.4%) had a recurrent stroke/TIA. When patients with prior stroke/TIA were analyzed by BPV quartiles, the incidence of recurrent stroke was higher in patients with high (≥ Q3) vs. low (P = 0.0134).Conclusions:In these patients at high-risk for secondary stroke, there is some evidence that management of BPV with antihypertensives is important to reduce the risk for recurrent stroke.

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