Effect of Intensive Versus Standard Blood Pressure Control on Stroke Subtypes
Year: 2021
Type: article
Abstract: In the SPRINT (Systolic Blood Pressure Intervention Trial), the number of strokes did not differ significantly by treatment group. However, stroke subtypes have heterogeneous causes that could respond differently to intensive blood pressure control. SPRINT participants (N=9361) were randomized to target systolic blood pressures of <120 mm Hg (intensive treatment) compared with <140 mm Hg (standard treatment). We compared incident hemorrhage, cardiac embolism, large- and small-vessel infarctions across treatment arms. Participants randomized to the intensive arm had mean systolic blood pressures of 121.4 mm Hg in the intensive arm (N=4678) and 136.2 mm Hg in the standard arm (N=4683) at one year. Sixty-nine strokes occurred in the intensive arm and 78 in the standard arm when SPRINT was stopped. The breakdown of stroke subtypes across treatment arms included hemorrhagic (intensive treatment, n=6, standard treatment, n=7) and ischemic stroke subtypes (large artery atherosclerosis: intensive treatment n=11, standard treatment, n=13; cardiac embolism: intensive treatment n=11, standard treatment n=15; small artery occlusion: intensive treatment n=8, standard treatment n=8; other ischemic stroke: intensive treatment n=3, standard treatment n=1). Fewer strokes occurred among participants without prior cardiovascular disease in the intensive (n=43) than the standard arm (n=61), but the difference did not reach predefined statistical significance level of 0.05 ( P =0.09). The interaction between baseline cardiovascular risk factor status and treatment arm on stroke risk did not reach significance ( P =0.05). Similar numbers of stroke subtypes occurred in the intensive BP control and standard control arms of SPRINT.
Source: Hypertension
Institutions: National Institutes of Health, National Institute of Neurological Disorders and Stroke, University of Mississippi Medical Center, Case Western Reserve University, Wake Forest University Health Sciences, Wake Forest University, Harvard University, Massachusetts General Hospital, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Tulane University, Mayo Clinic, Mayo Clinic in Florida, University of South Carolina, Georgetown University, University of California, Los Angeles, Emory University, Henry Ford Hospital, University of Alabama at Birmingham
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: National Institutes of Health, National Institute on Aging, National Heart, Lung, and Blood Institute, National Institute of General Medical Sciences, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Neurological Disorders and Stroke, National Center for Research Resources, National Center for Advancing Translational Sciences
Awards: Stanford Center for Clinical and Translational Education and Research (SCCTER)UL1, G1153142239, G1201304535, G130883262, G1346455397, Neurovascular Unit Dysfunction in Women with Severe Preeclampsia, G1442900148, G1452718737, G1534123016, G1575401839, G1815451664, G2244966566, The Ohio State University Center for Clinical and Translational Science (UL1), Tufts Clinical and Translational Research Institute, Stanford Center for Clinical & Translational Education and Research (Spectrum), G3042542605, Translational Research in Hypertension and Renal Biology, UC Davis Clinical and Translational Science Center, G3759862710, Clinical and Translational Science Institute at Children's National, UF Clinical and Translational Science Award, Genetic ancestry and antihypertensive medication responses in African Americans, G4988861893, SPRINT MIND 2020, G5068655555, G522538789, Institutional Clinical and Translational Science Award, G576625284, G5831220822, Tufts Clinical and Translation Science Institute (UL1), G5971433106, G742032275, Institutional Clinical and Translational Science Award, The Vanderbilt Institute for Clinical and Translational Research (VICTR), Clinical and Translational Science Collaborative of Cleveland, G8723760441, Clinical and Translational Science Collaborative of Cleveland, G884570035
OpenAlex ID: W3130962473