Effect of Standard vs Intensive Blood Pressure Control on the Risk of Recurrent Stroke: A Randomized Clinical Trial...

Area of Science:

• Neurology
• Cardiology
• Clinical Trials

Background:

• The Systolic Blood Pressure Intervention Trial (SPRINT) indicated a systolic blood pressure (BP) target <120 mm Hg is superior for preventing vascular events.
• SPRINT excluded prior stroke patients, leaving the ideal BP target for secondary stroke prevention unknown.

Purpose of the Study:

• To assess if intensive BP control reduces recurrent strokes compared to standard BP control.
• To evaluate the efficacy of intensive BP lowering for secondary stroke prevention.

Main Methods:

• A randomized clinical trial (RCT) comparing standard BP control (<140/90 mm Hg) vs. intensive BP control (<120/80 mm Hg) in patients with a history of stroke.
• 1263 patients were analyzed in an intent-to-treat population, with follow-up for a mean of 3.9 years.
• An updated meta-analysis pooled data from this RCT and 3 previous trials.

Main Results:

• Intensive BP control resulted in a non-significant trend toward reduced recurrent stroke (HR, 0.73; P=.15).
• The mean BP achieved was 133.2/77.7 mm Hg in the standard group and 126.7/77.4 mm Hg in the intensive group.
• The meta-analysis showed intensive BP control significantly reduced stroke recurrence risk (RR, 0.78; P=.02), with a number needed to treat of 67.

Conclusions:

• Intensive BP lowering demonstrated a tendency to decrease stroke recurrence.
• The combined evidence from the RCT and meta-analysis supports a target BP of <130/80 mm Hg for secondary stroke prevention.