Effect of Standard vs Intensive Blood Pressure Control on the Risk of Recurrent Stroke

Abstract

; for the Recurrent Stroke Prevention Clinical Outcome (RESPECT) Study Group IMPORTANCE The Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated that a systolic blood pressure (BP) target less than 120 mm Hg was superior to less than 140 mm Hg for preventing vascular events. This trial excluded patients with prior stroke; therefore, the ideal BP target for secondary stroke prevention remains unknown. OBJECTIVE To assess whether intensive BP control would achieve fewer recurrent strokes vs standard BP control. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial (RCT) of standard vs intensive BP control in an intent-to-treat population of patients who had a history of stroke. Patients were enrolled between October 20, 2010, and December 7, 2016. For an updated meta-analysis, PubMed and the Cochrane Central Library database were searched through September 30, 2018, using the Medical Subject Headings and relevant search terms for cerebrovascular disease and for intensive BP lowering. This was a multicenter trial that included 140 hospitals in Japan; 1514 patients who had a history of stroke within the previous 3 years were approached, but 234 refused to give informed consent. INTERVENTIONS In total, 1280 patients were randomized 1:1 to BP control to less than 140/90 mm Hg (standard treatment) (n = 640) or to less than 120/80 mm Hg (intensive treatment) (n = 640). However, 17 patients never received intervention; therefore, 1263 patients assigned to standard treatment (n = 630) or intensive treatment (n = 633) were analyzed. MAIN OUTCOMES AND MEASURES The primary outcome was stroke recurrence. RESULTS The trial was stopped early. Among 1263 analyzed patients (mean [SD] age, 67.2 [8.8] years; 69.4% male), 1257 of 1263 (99.5%) completed a mean (SD) of 3.9 (1.5) years of follow-up. The mean BP at baseline was 145.4/83.6 mm Hg. Throughout the overall follow-up period, the mean BP was 133.2/77.7 (95% CI, 132.5-133.8/77.1-78.4) mm Hg in the standard group and 126.7/77.4 (95% CI, 125.9-127.2/73.8-75.0) mm Hg in the intensive group. Ninety-one first recurrent strokes occurred. Nonsignificant rate reductions were seen for recurrent stroke in the intensive group compared with the standard group (hazard ratio [HR], 0.73; 95% CI, 0.49-1.11; P = .15). When this finding was pooled in 3 previous relevant RCTs in a meta-analysis, the risk ratio favored intensive BP control (relative risk, 0.78; 95% CI, 0.64-0.96; P = .02; absolute risk difference, −1.5%; 95% CI, −2.6% to −0.4%; number needed to treat, 67; 95% CI, 39-250). CONCLUSIONS AND RELEVANCE Intensive BP lowering tended to reduce stroke recurrence. The updated meta-analysis supports a target BP less than 130/80 mm Hg in secondary stroke prevention.

Impact of metabolic syndrome on short-term outcome of carotid revascularization: a large sample size study in Chinese population

“…[ 28 – 30 ] A previous systematic review showed that baseline blood pressure could affect the outcome of surgery, [ 31 ] and blood pressure control could lowering the risk of carotid revascularization. [ 32 ] Indeed, blood pressure control to lower the risk of recurrent of stroke has gained increasing attention in recent years. [ 32 ] Both hyperglycemia and hypertension are important components of MetS, and could impact micro-perfusion of the brain.…”

Addition of proprioceptive neuromuscular facilitation to cardiorespiratory training in patients poststroke: study protocol for a randomized controlled trial

“…Systolic pressure above 140 mmHg [31] Diastolic pressure above 100 mmHg Peripheral saturation below 90% At the request of the volunteer for excessive fatigue or pain…”

Evidence base regarding target levels of arterial pressure in patients after a stroke: focus on a geriatric population

“…На сегодняшний день проведены 6 крупных РКИ по изучению целевых уровней АД у пациентов с АГ и церебральными событиями в анамнезе: The Secondary Prevention of Small Subcortical Strokes (SPS3) [5], Рerindopril protection against recurrent stroke study (PROGRESS) [3], Prevention Regimen For Effectively Avoiding Second Strokes (PRoFESS) [6], Post-stroke Antihypertensive Treatment Study (PATS) [4], Morbidity and Mortality After Stroke, Eprosartan Compared With Nitrendipine for Secondary Prevention study (MOSES) [7] и Recurrent Stroke Prevention Clinical Outcome Study (RESPECT) [8]. Дизайн этих исследований и характеристика включенных пациентов представлены в табл.…”

“…[11] и 2019 г. [8]. В крупном РКИ SPS3 [5], в котором приняли участие 3020 пациентов (средний возраст 63 года) с перенесенным лакунарным инсультом (180 дней и менее перед рандомизацией), период наблюдения в среднем 3,7 года, показаны некоторые преимущества достижения целевого уровня САД<130 мм рт.…”

“…ст.) в профилактике повторных инсультов у пациентов, которые перенесли инсульт в анамнезе, представлено учеными из Японии [8]. В проспективном многоцентровом открытом РКИ RESPECT участвовали 1263 пациента в возрасте от 50 до 85 лет (средний возраст 67,2±8,8 года), перенесших инсульт в течение предыдущих 3 лет.…”