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Cohort study
High blood pressure while taking antithrombotic medication is associated with an increased risk of developing intracranial haemorrhage
  1. Adam J Rose,
  2. Elaine M Hylek
  1. Centre for Health Quality, Outcomes, and Economic Research, Bedford VA Medical Center and Boston University School of Medicine, Bedford, Massachusetts, USA
  1. Correspondence to Adam J Rose
    Center for Health Quality, Outcomes, and Economic Research, Bedford VA Medical Center, 200 Springs Road, Building 70, Bedford, MA 01730, USA; adamrose{at}

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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 …

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  • 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.