Introduction Whether obtaining the more intensive goal systolic blood pressure (SBP) of <130 mm Hg, rather than a less intensive SBP goal of <140 mm Hg poststroke/transient ischaemic attack (TIA) is associated with incremental mortality and recurrent vascular event benefit is largely unexplored using real-world data. Lowering SBP excessively may result in poorer outcomes. Methods This is a retrospective cohort study of 26 368 Veterans presenting to a Veterans Administration Medical Center (VAMC) with a stroke/TIA between October 2015 and July 2018. Patients were excluded from the study if they had missing or extreme BP values, receiving dialysis or palliative care, left against medical advice had a cancer diagnosis, were cared for in a VAMC enrolled in a stroke/TIA quality improvement initiative, died or had a cerebrovascular or cardiovascular event within 90 days after their index stroke/TIA. The analytical sample included 12 337 patients. Average SBP during 90 days after discharge was assessed in categories (≤105 mm Hg, 106–115 mm Hg, 116–130 mm Hg, 131–140 mm Hg and >140 mm Hg). Separate multivariable Cox proportional hazard regressions were used to examine the relationship between average SBP groups and time to: (1) mortality and (2) any recurrent vascular event, from 90 days to up to 365 days after discharge from the index emergency department visit or inpatient admission. Results Compared with those with SBP>140 mm Hg, patients with SBP between 116 and 130 mm Hg had a significantly lower risk of recurrent stroke/TIA (HR 0.77, 95% CI 0.60 to 0.99) but not cardiovascular events. Patients with SBP lower than 105 mm Hg, compared with those with >140 mm Hg demonstrated a statistically significant higher risk of death (HR 2.07, 95% CI 1.43 to 3.00), but no statistical differences were found in other SBP groups. Discussion Data support a more intensive SBP goal to prevent recurrent cerebrovascular events among stroke/TIA patients by 90 days poststroke/TIA compared with less intensive goal. Very low SBPs were associated with increased mortality risk. Data are available on reasonable request. VHA data are made freely available to researchers with an approved VHA study protocol; the analytical datasets used for this study are not permitted to leave the VA firewall without a data use agreement.

中文翻译：

---

两个缺血性卒中和 TIA 收缩压目标对 12 个月死亡率和复发性血管事件影响的真实世界分析

引言 中风后/短暂性脑缺血发作 (TIA) 后，获得 <130 mm Hg 的较高强度目标收缩压 (SBP)，而不是 <140 mm Hg 的较低强度 SBP 目标，是否与死亡率增加和复发性血管事件获益相关？很大程度上尚未使用现实世界的数据进行探索。过度降低收缩压可能会导致较差的结果。方法 这是一项回顾性队列研究，纳入了 2015 年 10 月至 2018 年 7 月期间因中风/TIA 到退伍军人管理局医疗中心 (VAMC) 就诊的 26 368 名退伍军人。如果患者血压值缺失或极端，接受透析，则被排除在研究之外或姑息治疗，未接受医疗建议，被诊断为癌症，在参与中风/TIA 质量改进计划的 VAMC 中接受护理，在中风/TIA 发生后 90 天内死亡或发生脑血管或心血管事件。分析样本包括 12 337 名患者。出院后 90 天内的平均收缩压按类别进行评估（≤105 毫米汞柱、106-115 毫米汞柱、116-130 毫米汞柱、131-140 毫米汞柱和 >140 毫米汞柱）。使用单独的多变量 Cox 比例风险回归来检查平均 SBP 组与以下时间之间的关系：(1) 死亡率和 (2) 任何复发性血管事件，从首次急诊科出院后 90 天到 365 天或住院。结果 与SBP>140 mm Hg的患者相比，SBP在116至130 mm Hg之间的患者复发卒中/TIA的风险显着降低（HR 0.77，95% CI 0.60至0.99），但心血管事件则无显着降低。与SBP>140mmHg的患者相比，SBP低于105mmHg的患者表现出统计学上显着更高的死亡风险（HR 2.07，95％CI 1.43至3.00），但在其他SBP组中没有发现统计学差异。讨论 与强度较低的目标相比，数据支持更强度的 SBP 目标，以预防中风/TIA 患者在中风/TIA 后 90 天再次发生脑血管事件。收缩压极低与死亡风险增加相关。可根据合理要求提供数据。VHA 数据可免费提供给拥有经批准的 VHA 研究方案的研究人员；未经数据使用协议，本研究使用的分析数据集不得离开 VA 防火墙。