TitleAchieved Blood Pressure and Outcomes in the Secondary Prevention of Small Subcortical Strokes Trial.
Publication TypeJournal Article
Year of Publication2016
AuthorsOdden, MC, McClure, LA, B Sawaya, P, White, CL, Peralta, CA, Field, TS, Hart, RG, Benavente, OR, Pergola, PE
JournalHypertension
Volume67
Issue1
Pagination63-9
Date Published2016 Jan
ISSN1524-4563
KeywordsAspirin, Blood Pressure, Blood Pressure Determination, Drug Therapy, Combination, Female, Humans, Hypertension, Magnetic Resonance Imaging, Male, Middle Aged, Platelet Aggregation Inhibitors, Recurrence, Secondary Prevention, Severity of Illness Index, Stroke, Lacunar, Ticlopidine, Treatment Outcome
Abstract
 

UNLABELLED: Studies suggest a J-shaped association between blood pressure and cardiovascular events in the setting of intensive systolic blood pressure control; whether there is a similar association with stroke remains less well established. The Secondary Prevention of Small Subcortical Strokes was a randomized trial to evaluate higher (130-149 mm Hg) versus lower (<130 mm Hg) systolic blood pressure targets in participants with recent lacunar infarcts. We evaluated the association of mean achieved blood pressure, 6 months after randomization, and recurrent stroke, major vascular events, and all-cause mortality. After a mean follow up of 3.7 years, there was a J-shaped association between achieved blood pressure and outcomes; the lowest risk was at ≈124 and 67 mm Hg systolic and diastolic blood pressure, respectively. For example, above a systolic blood pressure of 124 mm Hg, 1 standard deviation higher (11.1 mm Hg) was associated with increased mortality (adjusted hazard ratio: 1.9; 95% confidence interval: 1.4, 2.7), whereas below this level, this relationship was inverted (0.29; 0.10, 0.79), P<0.001 for interaction. Above a diastolic blood pressure of 67 mm Hg, a 1 standard deviation higher (8.2 mm Hg) was associated with an increased risk of stroke (2.2; 1.4, 3.6), whereas below this level, the association was in the opposite direction (0.34; 0.13, 0.89), P=0.02 for interaction. The lowest risk of all events occurred at a nadir of ≈120 to 128 mm Hg systolic blood pressure and 65 to 70 mm Hg diastolic blood pressure. Future studies should evaluate the impact of excessive blood pressure reduction, especially in older populations with preexisting vascular disease.

CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00059306.

DOI10.1161/HYPERTENSIONAHA.115.06480
Alternate JournalHypertension
PubMed ID26553236
PubMed Central IDPMC4679688
Grant ListK01 AG039387 / AG / NIA NIH HHS / United States
R01AG46206 / AG / NIA NIH HHS / United States
U01 NS038529 / NS / NINDS NIH HHS / United States
K01AG039387 / AG / NIA NIH HHS / United States
U01NS038529 / NS / NINDS NIH HHS / United States
R01 AG046206 / AG / NIA NIH HHS / United States
P30 AG044281 / AG / NIA NIH HHS / United States