Targeting systolic blood pressure below 120 mm Hg in patients with prior stroke did not significantly reduce major cardiovascular events compared to standard control (HR 0.88; 95% CI 0.72-1.07; P=0.191).
RCT (n=3,022)
Does intensive blood pressure control targeting SBP below 120 mm Hg reduce major cardiovascular events in patients with prior stroke?
Intensive blood pressure control targeting SBP <120 mm Hg in patients with prior stroke showed a non-significant trend toward reduced major cardiovascular events without increasing serious adverse events.
Effect estimate: HR 0.88 (95% CI 0.72, 1.07)
Absolute Event Rate: 12.3% vs 13.9%
p-value: p=0.191
Abstract Background Blood pressure (BP) lowering has been recommended for hypertension in patients with stroke in the current guidelines. Whether the evidence of more aggressive systolic blood pressure (SBP) control targeting below 120 mm Hg in patients with prior stroke on major cardiovascular events remains unknown. Purpose We aimed to examine the effects of targeting SBP below 120 mm Hg among patients with prior stroke on major cardiovascular events, a pre-specified subgroup of interest in the ESPRIT trial. Methods We included patients with prior stroke from the ESPRIT trial. The primary outcome was major cardiovascular events. We employed Cox proportional hazards regression to examine the efficacy and safety of intensive BP lowering treatment on the primary outcome and to evaluate its effects across stroke subtypes and time from stroke diagnosis. We conducted a meta-analysis on prior trials of intensive BP lowering in patients with prior stroke. Results Our study included 3022 patients, with a mean age of 64.1±7.2 years. During the median follow-up of 3.4 years, the primary outcome occurred in 187 (12.3%) of 1520 patients from the intensive group and 209 (13.9%) of 1502 from the standard group (HR 0.88; 95% CI 0.72, 1.07; P = 0.191). Neither stroke subtypes nor duration subgroups showed heterogeneity in the effect on the primary outcome. Intensive treatment did not increase the risk of serious adverse events (HR 1.03; 95% CI 0.93, 1.15; P = 0.558). When this finding was pooled with the RESPECT trial, the risk ratio favored intensive BP control (relative risk, 0.86; 95% CI, 0.70, 1.04). Conclusions In patients with prior stroke, targeting SBP below 120 mm Hg had benefits of major vascular events without unnecessarily excess risks of serious adverse events. The effect was consistent across the history of stroke subtypes and duration of stroke.
Li et al. (Sat,) conducted a rct in Prior stroke (n=3,022). Intensive blood pressure control vs. Standard blood pressure control was evaluated on Major cardiovascular events (HR 0.88, 95% CI 0.72, 1.07, p=0.191). Targeting systolic blood pressure below 120 mm Hg in patients with prior stroke did not significantly reduce major cardiovascular events compared to standard control (HR 0.88; 95% CI 0.72-1.07; P=0.191).