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Major haemorrhage, particularly intracranial haemorrhage (ICH), is a dreaded consequence of antithrombotic therapy. Strategies to mitigate this risk are needed as indications for antithrombotic therapy increasingly extend to older, high-risk patients. A previous large-scale randomised controlled trial demonstrated the benefits of lowering blood pressure (BP) in preventing recurrent stroke.1 In addition, a posthoc analysis of pooled data from the SPORTIF trials suggested a threshold BP of <140/80 mm Hg to decrease risk of stroke. In that study, extrapolation to haemorrhagic stroke was limited by the small number of ICH events (n=17).2 The current study sought to validate these findings in a non-trial setting and to better define the temporal relationship between BP and recurrent stroke.
The study focused on a prospective, observational cohort of 4009 patients from 19 stroke and cardiovascular centres in Japan. All patients were receiving antiplatelet agents and/or warfarin for cardiovascular prevention; most (57%) had a …
Competing interests AJR has no competing interests to report. EMH has received honoraria from Bayer and Bristol Myers Squibb and is on the advisory boards for Boehringer-Ingelheim, Bristol Myers Squibb, Merck and Sanofi Aventis.