Blood pressure levels and the risk of intracerebral hemorrhage after ischemic stroke

OBJECTIVE: To investigate the association between blood pressure (BP) levels and risk of intracerebral hemorrhage (ICH) after ischemic stroke. METHODS: We performed a post hoc analysis of data from the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial, a randomized clinical trial including 20,332 patients with recent noncardioembolic ischemic stroke. BP measurements were divided into predefined categories. We calculated incidence rates per BP category and performed multivariable Cox regression analysis with systolic blood pressure (SBP) and diastolic blood pressure (DBP) categories as time-dependent covariables. RESULTS: One hundred thirty-three ICHs occurred during 50,778 person-years of follow-up, resulting in an incidence rate of 2.6 per 1,000 person-years. The incidence rate of ICH increased with increasing SBP and DBP categories. Risk of ICH was significantly higher in patients with SBP >/=160 mm Hg (hazard ratio 2.27, 95% confidence interval 1.34-3.86) compared with those with SBP of 130-/=100 mm Hg (hazard ratio 3.08, 95% confidence interval 1.78-5.34) compared with those with DBP of 80-