SPS3: Lower BP targets, DAPT did not affect cognition in lacunar stroke

SAN DIEGO — Aggressive BP lowering and dual antiplatelet therapy did not improve the cognitive function of patients with lacunar stroke, according to new data from the SPS3 trial.

Researchers observed a modest decline in the patients’ cognitive function during the first year after a lacunar stroke, but neither lower BP targets nor DAPT modified the rate of decline, Oscar R. Benavente, MD, professor of neurology at the University of British Columbia, Vancouver, Canada, said at the International Stroke Conference.

The SPS3 trial included 3,020 patients (mean age, 63 years; mean Mini-Mental State Examination score, 28) with lacunar strokes verified by MRI. Researchers randomly assigned participants to two interventions in a factorial design. In a double blind randomization, patients were assigned aspirin 325 mg/clopidogrel 75 mg or aspirin 325 mg/placebo. In an open-label randomization, patients were assigned a target systolic BP of 130 mm Hg to 149 mm Hg (n=1,519) or <130 mm Hg (n=1,501). BP medication was not specified by protocol or discontinued at study entry, and researchers could use increasing doses of existing medications or add new medications to lower BP as they saw fit, according to the study design.

Oscar R. Benavente

Benavente presented the findings on a secondary outcome of cognitive decline. In the overall SPS3 study, results of which were presented at the 2012 International Stroke Conference, the addition of clopidogrel to aspirin therapy did not prevent recurrent stroke and increased risks for bleeding and death in this patient population.

“Patients underwent neuropsychological testing at baseline and each year thereafter, but test results after a recurrent stroke were excluded,” Benavente said. The Cognitive Abilities Screening Instrument (CASI) z score was used to determine the effectiveness of interventions.

Mean follow-up was 3.6 years. Data were available on 2,916 patients with baseline assessment, and the average number of assessments per patient was 3.3, Benavente said.

Cognition, based on CASI z scores, did not differ with time between the groups randomly assigned by BP target (P=.3) or by antiplatelet therapy (P=.95). There also was no difference in score (P=.26) when four groups of patients were analyzed: lower BP target and DAPT, lower BP target and aspirin alone, higher BP target and DAPT, and higher BP target and aspirin alone, Benavente said.

“Other tests were also looked at for interactions with the interventions, and there was no benefit for any BP control or antiplatelet therapy” by those measures either, he said. – by Erik Swain

For more information:

Benavente OR. Late-Breaking Science Oral Abstracts: Abstract LB4. Presented at: International Stroke Conference 2014; Feb. 12-14, 2014; San Diego.

Disclosure: Benavente reports no relevant financial disclosures.