Systolic blood pressure and recurrent stroke in patients with different lesion patterns on diffusion weighted imaging

Pan Chen, Qiong Wu, Xuewei Xie, Jing Jing, Hongqiu Gu, Xianwei Wang, Xia Meng, Liping Liu, Yilong Wang, Yongjun Wang, CHANCE Investigators, Pan Chen, Qiong Wu, Xuewei Xie, Jing Jing, Hongqiu Gu, Xianwei Wang, Xia Meng, Liping Liu, Yilong Wang, Yongjun Wang, CHANCE Investigators

Abstract

Little is known about the relationship between baseline systolic blood pressure (SBP) and subsequent clinical events in patients with different lesion patterns on diffusion weighted imaging (DWI). We analyzed the Acute Non-disabling Cerebrovascular Events (CHANCE) trial dataset. Patients were categorized into negative DW imaging (no detectable lesions), lacunar infarction (single lesion ≤15 mm) and non-lacunar infarction (single lesion >15 mm or multiple lesions) based on lesion patterns on DWI. The primary outcome was recurrent stroke within 90 days. Cox proportional hazards models were used to assess the association between SBP levels and stroke outcomes in patients with different lesion patterns. A total of 1089 patients were analyzed. We found 258 cases (23.7%) with negative DW imaging, 392 (36.0%) with lacunar infarction and 439 (40.3%) with non-lacunar infarction. Patients with non-lacunar infarction had the highest incidence of stroke at 90-day (P < .001). In non-lacunar infarction group, compared with SBP < 160 mmHg, patients with SBP ≥ 160 mmHg had significantly higher risk of 90-day recurrent stroke (20.3% vs. 10.7%; adjusted hazard ratio 1.81, 95% confidence interval 1.09-3.00). No significant association was found between SBP and clinical outcomes in patients with negative DWI and lacunar stroke groups. The result at 1 year was similar as at 90-day. Therefore, non-lacunar infarction, the most common lesion pattern in CHANCE study, had the highest risk of recurrent stroke and combined vascular events both in 90 days and 1 year. High baseline SBP was significantly associated with increased risk of short- and long-term recurrent strokes in patients with non-lacunar infarction.

Trial registration: ClinicalTrials.gov NCT00979589.

Keywords: blood pressure; diffusion-weighted imaging; ischemic stroke; transient ischemic attack.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022 The Authors. The Journal of Clinical Hypertension published by Wiley Periodicals LLC.

Figures

FIGURE 1
FIGURE 1
Crude event rates in patients with different lesion patterns on DWI. CVE, combined vascular events

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