Article Figures & Data
- Figure 1
Flow chart of eligible veterans with ischaemic stroke and TIA to examine the relationship between systolic blood pressure control at 90 days and mortality and recurrent vascular events at 12 months. TIA, transient ischaemic attack.
- Figure 2
Number of systolic blood pressure readings by postischaemic stroke/TIA discharge day. SBP, systolic blood pressure; TIA, transient ischaemic attack.
- Figure 3
Predicted probability (with CIs) for mortality within 12 months by systolic blood pressure intervals (N=9065). Predicted probability of all-cause mortality within 12 months by systolic blood pressure obtained at 90 days postischaemic stroke/transient ischaemic attack.
- Table 1
Baseline characteristics of ischaemic stroke/TIA patients cohort surviving 90 days postcerebrovascular event cohort (N=12 337)
Characteristic Mean (SD) or % Sociodemographic Age 69.05 (10.8) Sex, male 95.3 Race White 70.2 Black 24.5 Asian 0.7 Other 0.6 Unknown 4.0 Hispanic 7.5 Systolic blood pressure groupings (mm Hg) ≤105 3.6 106 to ≤115 10.3 116 to ≤130 34.9 131 to ≤140 27.4 > 140 23.7 Index Cerebrovascular Event-Final Diagnosis Ischaemic stroke 64.0 TIA 36.0 FY of presentation FY2016 37.3 FY2017 36.5 FY2018 26.2 Healthcare utilisation No of admissions in 1 year prior to presentation 0.31 (0.78) No of ED presentations in 1 year prior to presentation 1.25 (2.12) Length of hospitalisation stay (days) 3.90 (7.12) ED presentation of index event 91.0 Hospital admission of index event 83.5 Medical history* Ischaemic stroke 56.7 TIA 26.0 Hemiplegia 34.3 Hypertension 79.0 Hyperlipidaemia 64.1 Diabetes 43.0 Atrial fibrillation 13.9 Other arrhythmia 11.0 CHF 11.9 MI 6.2 CEA/carotid stent 0.9 PAD 12.6 OSA 14.9 Chronic kidney disease 15.6 Current smoker 33.3 Alcohol dependence 9.7 Dementia 7.3 Depression 22.5 Additional clinical indicators CCI 2.20 (2.22) Modified APACHE III score 9.73 (6.36) Concomitant illness within 1 day of cerebrovascular event presentation MI 2.6 CHF 1.6 *Medical history variables identified by International Classification of Diseases, Ninth Edition Code.
APACHE, Acute Physiology and Chronic Health Evaluation; CCI, Charlson Comorbidity Index; CEA, carotid endarterectomy; CHF, congestive heart failure; ED, emergency department; FY, fiscal year; MI, myocardial infarction; OSA, obstructive sleep apnoea; PAD, peripheral arterial disease; SBP, systolic blood pressure; TIA, transient ischaemic attack; VA, Veterans Affairs.
- Table 2
Descriptive table of 12-month patient outcomes stratified by SBP levels (N=12 337)
SBP≤105(1) 105<SBP≤115(2) 115<SBP≤130(3) 130<SBP≤140(4) SBP>140(5) Total P value* Total (%) 3.6 10.3 34.9 27.4 23.7 100 SBP measurements Mean (SD) 2.39 (1.92) 2.90 (2.01) 3.19 (2.23) 3.22 (2.28) 3.15 (2.00) 3.14 (2.16) <0.001† Outcomes Recurrent ischaemic stroke/TIA 22 (7.7) 66 (6.3) 236 (5.6) 214 (6.2) 212 (6.4) 750 (6.1) 0.438 Cardiovascular events‡ 5 (1.7) 15 (1.4) 83 (2.0) 72 (2.1) 58 (1.8) 233 (6.1) 0.671 Total vascular events§ 24 (8.4) 80 (7.7) 304 (7.2) 275 (8.0) 260 (7.8) 943 (7.7) 0.732 All-cause mortality 28 (9.8) 38 (3.7) 143 (3.4) 98 (2.8) 123 (3.7) 430 (3.5) <0.001 *P values from χ2 or one-way ANOVA.
†Significant contrasts from one-way ANOVA (Scheffe test, p<0.05): (1) less than (2–5); (2) greater than (1); (3) greater than (1, 2); (4) greater than (1, 2) and (5) greater than (1, 2).
‡Cardiovascular Events: myocardial infarction/acute coronary syndrome, ventricular arrhythmias.
§Total Vascular Events: recurrent stroke/TIA, myocardial infarction/acute coronary syndrome, ventricular arrhythmias.
ANOVA, analysis of variance; SBP, systolic blood pressure; TIA, transient ischaemic attack.
- Table 3
Distinct systolic blood pressure readings postdischarge per ischaemic stroke/TIA patient (N=12 337)
Distinct blood pressure measurements n (%) 1 5016 40.75 2 4020 32.66 3 2028 16.47 4 785 6.38 5 309 2.51 6 95 0.77 7 34 0.28 8 17 0.14 9 4 0.03 10 0 0.00 11 2 0.02 TIA, transient ischaemic attack.
- Table 4
Multivariable Cox proportional hazard regression for survival (N=12 337)*
Variable Survival since 90 days after discharge up to 12 months HR (95% CI) PH assumption test Systolic blood pressure groupings (mm Hg) ≤105 2.07 (1.43 to 3.00) 0.58 106 to ≤115 1.14 (0.83 to 1.57) 0.11 116 to ≤130 0.91 (0.71 to 1.17) <0.001 131 to ≤140 0.82 (0.63 to 1.07) 0.11 >140 Ref Age 1.06 (1.05 to 1.07) 0.16 Yes 0.77 (0.54 to 1.10) <0.001 Healthcare utilisation No of admissions in 1 year prior to presentation 1.20 (1.07 to 1.35) 0.63 Length of stay No of ED presentations in 1 year prior to presentation 0.94 (0.89 to 1.00) 0.95 Medical history† Hyperlipidaemia No Ref Yes 0.68 (0.56 to 0.83) 0.32 Atrial fibrillation No Ref Yes 1.27 (1.02 to 1.59) 0.79 OSA No Ref Yes 0.66 (0.48 to 0.91) 0.16 Dementia No Ref Yes 1.80 (1.41 to 2.29) 0.21 CCI 1.11 (1.06 to 1.16) 0.74 APACHE 1.02 (1.00 to 1.03) 0.37 *PH assumption test=proportional hazard assumption test. A p≥0.05 indicates that the HR is constant over time. A p<0.05 indicates violation of the proportional hazard assumption for the model.
†Medical history variables identified by International Classification of Diseases, Ninth Edition Code.
APACHE, Acute Physiology and Chronic Health Evaluation; CCI, Charlson Comorbidity Index; ED, emergency department; OSA, obstructive sleep apnoea; PH, proportional hazard; TIA, transient ischaemic attack.
- Table 5
Multivariable Cox proportional hazard regression for cerebrovascular recurrence, cardiovascular recurrence and both combined, with death as a competing risk (N=12 337)
Model 1—recurrent cardiovascular event* Model 2—recurrent cerebrovascular event† Model 3—recurrence of either vascular event‡ Characteristic HR (95% CI) Systolic blood pressure groupings (mm Hg) ≤105 0.90 (0.63 to 1.30) 0.87 (0.51 to 1.47) 0.92 (0.55 to 1.53) 106 to ≤115 0.95 (0.74 to 1.21) 0.99 (0.71 to 1.38) 0.89 (0.62 to 1.28) 116 to ≤130 0.92 (0.77 to 1.10) 0.77 (0.60 to 0.99) 1.09 (0.84 to 1.41) 131 to ≤140 1.02 (0.84 to 1.23) 1.10 (0.86 to 1.40) 0.89 (0.66 to 1.19) >140 Ref Ref Ref Age 1.01 (1.00 to 1.02) 1.01 (1.00 to 1.02) 1.01 (1.00 to 1.02) No of ED presentations in 1 year prior to presentation 1.09 (1.07 to 1.11) 1.07 (1.05 to 1.10) 1.11 (1.08 to 1.13) ED presentation of index event No Ref Yes 1.33 (1.02 to 1.73) — — Medical history§ Ischaemic stroke No — Ref — Yes — 1.26 (1.04 to 1.52) Hemiplegia No — — Ref Yes — — 0.72 (0.58 to 0.90) Diabetes No Ref Ref — Yes 1.28 (1.10 to 1.50) 1.47 (1.23 to 1.77) — Atrial fibrillation No Ref Ref Yes 1.34 (1.12 to 1.59) — 1.65 (1.29 to 2.12) CHF No Ref Ref Yes 1.76 (1.46 to 2.12) 2.77 (2.13 to 3.61) MI No Ref — Ref Yes 1.45 (1.17 to 1.80) — 1.65 (1.23 to 2.21) Current smoker No — Ref — Yes — 1.32 (1.09 to 1.61) — CCI 1.05 (1.02 to 1.09) — 1.10 (1.05 to 1.14) APACHE 1.01 (1.00 to 1.02) — 1.02 (1.01 to 1.04) *Model 1—Recurrent cerebrovascular events only with death as a competing risk.
†Model 2—Recurrent cardiovascular events only with death as a competing risk.
‡Model 3—Combined recurrent cerebrovascular events and recurrent cardiovascular events with death as a competing risk.
§Medical history variables identified by International Classification of Diseases to Ninth Edition Code.
APACHE, Acute Physiology and Chronic Health Evaluation; CCI, Charlson Comorbidity Index; CHF, congestive heart failure; ED, Emergency Department; MI, myocardial infarction.
Supplementary Materials
Supplementary data
Supplementary data
Supplementary data
Supplementary data
Supplementary data
Additional Files
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
