Authors Say Lower BP Targets May Cut Recurrent Stroke Risk

Intensive blood pressure (BP) lowering nonsignificantly reduces the risk for recurrence among patients with a history of stroke compared with a standard BP-lowering regimen, according to a study published online in JAMA Neurology.

Kazuo Kitagawa, M.D., Ph.D., from the Women's Medical University in Tokyo, and colleagues randomly allocated patients with a history of stroke to BP control to less than 140/90 mm Hg (standard treatment) or to less than 120/80 mm Hg (intensive treatment); the analysis included 630 and 633 patients in the standard and intensive treatment groups, respectively.

Enrollment in the trial was stopped early because of slow recruitment and lack of funding; 99.5 percent of patients completed a mean of 3.9 years of follow-up. The researchers found that the mean BP was 133.2/77.8 mm Hg and 126.7/77.4 mm Hg in the standard and intensive treatment groups, respectively, throughout overall follow-up. There were 91 first recurrent strokes. Compared with the standard group, the intensive treatment group had nonsignificant rate reductions in recurrent stroke (hazard ratio, 0.73; 95 percent confidence interval, 0.49 to 1.11; P = 0.15). The risk ratio favored intensive BP control when the data from this trial were pooled with the results from three previous relevant randomized controlled trials (relative risk, 0.78; 95 percent confidence interval, 0.64 to 0.96; P = 0.02).

This article "is an important addition to this evidence base, not only in providing further support for the benefits of more intensive BP lowering for secondary stroke prevention but also in defining some of the complexities to achieving this goal in both research and practice," write the authors of an accompanying editorial.

Several authors disclosed financial ties to the pharmaceutical industry.

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