{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T18:27:49Z","timestamp":1788546469345,"version":"build-2803163510"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T00:00:00Z","timestamp":1765584000000},"content-version":"vor","delay-in-days":195,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,6,1]],"date-time":"2025-06-01T00:00:00Z","timestamp":1748736000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,6,1]],"date-time":"2025-06-01T00:00:00Z","timestamp":1748736000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100000832","name":"Dowager Countess Eleanor Peel Trust","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000832","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000832","name":"Dowager Countess Eleanor Peel Trust","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000832","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Adverse cardiac events following ischaemic stroke (stroke-heart syndrome, SHS) pose a clinical challenge. We investigated the association between initial blood pressure at stroke presentation and the risk of SHS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We utilised data from the Virtual International Stroke Trials Archive (VISTA). We defined SHS as the incidence of cardiac complications within 30\u2009days post-ischaemic stroke. These presentations included acute coronary syndrome encompassing myocardial injury, heart failure\/left ventricular dysfunction, atrial fibrillation\/flutter, other arrhythmia\/electrocardiogram abnormalities, and cardiorespiratory arrest. Using Cox proportional hazards models, we assessed the risk trajectories for developing SHS and its presentations associated with initial blood pressure. We also explored the risk trajectories for 90-day mortality related to initial blood pressure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>From 16,095 patients with acute ischaemic stroke, 14,965 (mean age 69\u2009\u00b1\u200912\u2009years; 55% male) were analysed. Of these, 1774 (11.8%) developed SHS. The risk of SHS and initial blood pressure showed a U-shaped relationship. The lowest blood pressures (\u2a7d130\u2009mmHg systolic and \u2a7d55\u2009mmHg diastolic) were associated with the highest risks (adjusted hazard ratio [95%confidence interval]: 1.40 [1.21\u20131.63]; p\u2009&amp;lt;\u20090.001, 1.71 [1.39\u20132.10]; p\u2009&amp;lt;\u20090.001, respectively, compared to referential blood pressure range).<\/jats:p>\n                    <jats:p>Cardiorespiratory arrest posed the greatest risk at higher blood pressure levels (2.34 [1.16\u20134.73]; p\u2009=\u20090.017 for systolic blood pressure &amp;gt;190\u2009mmHg), whereas other presentations exhibited the highest risk at lower pressures. The 90-day mortality risk also followed a U-shaped distribution, with greater risks observed at high blood pressure thresholds.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>There is a U-shaped relationship between initial blood pressure at ischaemic stroke presentation and the risk of subsequent SHS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23969873241296391","type":"journal-article","created":{"date-parts":[[2024,10,30]],"date-time":"2024-10-30T11:44:45Z","timestamp":1730288685000},"page":"469-477","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Initial blood pressure and adverse cardiac events following acute ischaemic stroke: An individual patient data pooled analysis from the VISTA database"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4597-7862","authenticated-orcid":false,"given":"Hironori","family":"Ishiguchi","sequence":"first","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK 1"},{"name":"Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan 2"},{"name":"Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK 3"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bi","family":"Huang","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK 1"},{"name":"Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK 3"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wahbi K.","family":"El-Bouri","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK 1"},{"name":"Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK 3"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7532-2475","authenticated-orcid":false,"given":"Jesse","family":"Dawson","sequence":"additional","affiliation":[{"name":"School of Cardiovascular and Metabolic Health, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK 4"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7566-1626","authenticated-orcid":false,"given":"Gregory Y. H.","family":"Lip","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK 1"},{"name":"Danish Centre for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark 5"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1318-4027","authenticated-orcid":false,"given":"Azmil H.","family":"Abdul-Rahim","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK 1"},{"name":"Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK 3"},{"name":"Stroke Division, Department Medicine for Older People, Mersey and West Lancashire Teaching Hospitals NHS Trust, Prescot, UK 6"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the VISTA Collaborators*","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,6,1]]},"reference":[{"key":"2026012113114174400_bibr1-23969873241296391","doi-asserted-by":"crossref","first-page":"2295","DOI":"10.1161\/STROKEAHA.106.471813","article-title":"Predictors of early cardiac morbidity and mortality after ischemic stroke","volume":"38","author":"Prosser","year":"2007","journal-title":"Stroke"},{"key":"2026012113114174400_bibr2-23969873241296391","doi-asserted-by":"crossref","first-page":"2768","DOI":"10.1016\/j.jacc.2020.10.009","article-title":"Post-stroke cardiovascular complications and neurogenic cardiac injury: JACC state-of-the-art review","volume":"76","author":"Sposato","year":"2020","journal-title":"J Am Coll 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