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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

Blood-pressure targets in patients with recent lacunar stroke: the SPS3 randomised trial

, O R Benavente, C S Coffey

    Lancet (London, England)
    |June 4, 2013
    PubMed

    Insights

    Lowering systolic blood pressure to less than 130 mm Hg may benefit patients with recent lacunar stroke. While not statistically significant for all stroke events, this target significantly reduced intracerebral hemorrhage rates.

    Area of Science:

    • Neurology
    • Cardiovascular Medicine
    • Clinical Trials

    Background:

    • Optimal blood pressure targets for preventing recurrent stroke after lacunar infarction are not well-established.
    • Lowering blood pressure is known to prevent initial strokes, but its efficacy in secondary prevention of lacunar stroke requires further investigation.

    Purpose of the Study:

    • To investigate the effects of different systolic blood pressure targets on the rate of recurrent stroke in patients with recent lacunar stroke.
    • To determine if a lower blood pressure target ( < 130 mm Hg) is more effective than a higher target (130-149 mm Hg) in preventing recurrent strokes.

    Main Methods:

    • A randomized open-label trial involving 3020 patients with recent, MRI-defined symptomatic lacunar infarctions across North America, Latin America, and Spain.
    • Patients were assigned to either a systolic blood pressure target of 130-149 mm Hg or less than 130 mm Hg.
    • The primary endpoint was the reduction in all stroke events, including ischemic strokes and intracranial hemorrhages. Intention-to-treat analysis was performed.

    Main Results:

    • After a mean follow-up of 3.7 years, the lower blood pressure target group (mean SBP 127 mm Hg) showed non-significant rate reductions for all stroke (HR 0.81) and disabling/fatal stroke (HR 0.81).
    • A significant reduction in the rate of intracerebral hemorrhage (HR 0.37) was observed in the lower target group compared to the higher target group (mean SBP 138 mm Hg).
    • The composite outcome of myocardial infarction or vascular death also showed a non-significant reduction (HR 0.84) with the lower target. Treatment-related serious adverse events were infrequent.

    Conclusions:

    • While the overall reduction in stroke events did not reach statistical significance, the findings suggest a potential benefit of targeting a systolic blood pressure of less than 130 mm Hg in patients with recent lacunar stroke.
    • The significant reduction in intracerebral hemorrhage rates supports the safety and potential efficacy of a lower blood pressure target in this patient population.
    Abstract

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