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SPS3: Lowering systolic BP targets may prevent recurrent stroke
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Lowering systolic BP to a target of less than 130 mm Hg for patients with small subcortical strokes reduced the risk for recurrent stroke, according to research presented at the International Stroke Conference 2013.
In the SPS3 trial, 3,020 patients with small subcortical strokes verified by MRI were randomly assigned to 325 mg aspirin daily or 325 mg aspirin plus 75 mg clopidogrel daily and into two target groups of systolic BP control (<130 mm Hg or 130-149 mm Hg). Outcomes were compared between those assigned to the lower target of <130 mm Hg and those assigned the higher target of 130-149 mm Hg.
Oscar R. Benavente
During a mean follow-up of 3.7 years, there were 277 first recurrent strokes. Researchers found that the rate of recurrent stroke was 2.77% per year in the higher target group (mean systolic BP, 136 mm Hg) compared with 2.25% in the lower target group (mean systolic BP, 125 mm Hg; HR=0.81; 95% CI, 0.64-1.03). The lower BP target was also associated with a 63% significant reduction in intracerebral hemorrhage, according to a press release.
Both levels of treatment were safe. Fainting was the most frequently reported adverse event, but occurred in less than 1% of patients in each group. Serious adverse events from BP reduction occurred in 1% of the higher target group and 1.5% in the lower target group, according to the release.
At a press conference, Oscar R. Benavente, MD, professor and research director of stroke at the University of British Columbia, Canada, said, “It was feasible to achieve targets of BP control in the trial. Treatment was safe and well tolerated.”
"What the study tells us is that a systolic reading of 135 mm Hg may not be enough, but that getting BP down to below 130 mm Hg may offer our stroke patients greater clinical benefits,” Benavente stated in a press release. "I would tell my patients who had this type of stroke to get their BP below 130 [mm Hg]."
For more information:
Benavente O. LB8. Presented at: International Stroke Conference 2013; Feb. 5-8, 2013; Honolulu.
Disclosure: Benavente reports funding from the National Institute of Neurological Disorders and Stroke.
Perspective
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Philip B. Gorelick, MD, MPH
This particular study focused on just small-vessel strokes, which is very unique. The key message is that if you lower BP in patients who have small, deep strokes or lacunar infarcts, you are going to reduce the risk for brain hemorrhage. The big question that always comes up is: How low do you lower the BP? In diabetic populations, the American Diabetes Association 2013 guidelines now state that instead of a systolic BP target <130/80 mm Hg the recommended target is <140 mm Hg. The PROGRESS trial showed that lowering BP can also reduce the risk for ischemic stroke. These investigators at ISC were on the way of showing that, but it didn't quite reach that statistical significance. They estimated that there is close to a 20% reduction of stroke risk by lowering BP.
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