Intensive BP reduction strategy fails to lower stroke recurrence

Intensive BP lowering did not significantly reduce stroke recurrence, according to data from the RESPECT study presented at the International Stroke Conference.

Kazuo Kitagawa, MD, PhD, of Tokyo Women’s Medical University in Japan, and colleagues presented an evaluation of the effects of intensive vs. standard BP-lowering regimen on the rate of recurrent stroke among patients with recent stroke.

For the open-label trial, between October 2010 and December 2015, patients were randomly assigned to standard treatment (BP control to < 140/90 mm Hg) or to intensive treatment (BP control to < 120/80 mm Hg). The primary endpoint was the time to the first recurrent stroke, including ischemic stroke and intracerebral hemorrhage.

The trial ended early on Dec. 31, 2016, because of slow recruitment and the halting of funding after 1,263 patients were enrolled, with 630 in the standard treatment group and 633 in the intensive treatment group (mean age, 67 years; 68% men; mean follow-up, 3.9 years), Kitagawa said during the presentation.

After 1 year, the standard treatment group had a higher mean BP (132/77.5 mm Hg; 95% CI, 130.9-133/76.6-78.3) compared with the intensive target group (123.7/72.8 mm Hg; 95% CI, 122.6-124.8/72-73.7).

According to the researchers, the incidence of recurrent stroke was 1.65% per year in the intensive group and 2.26% per year in the standard group (HR = 0.73; 95% CI, 0.49-1.11).

The annual rate of ischemic stroke was 1.6% in the intensive group and 1.76% in the standard group (HR = 0.91; 95% CI, 0.59-1.42), Kitagawa said.

When RESPECT was added to three other trials in a meta-analysis, however, intensive BP lowering remained associated with reduced risk for recurrent stroke (RR = 0.78; 95% CI, 0.64-0.96).

“The nonsignificant findings might be attributable to insufficient statistical power due to early termination of the trial or the modest difference in blood pressure level between groups,” Kitagawa and colleagues wrote. “Nevertheless, the updated meta-analysis including this trial supports the target blood pressure of less than 130/80 mm Hg in the secondary prevention of stroke.” – by Earl Holland, Jr.

Reference:

Kitagawa K, et al. LB10. Presented at: International Stroke Conference; Feb. 6-8, 2019; Honolulu.

Disclosures: The study was funded by Bristol-Myers Squibb, Merck, Omron and Towa. Kitagawa reports he received research support from and serves on the speakers bureau for Merck Sharpe & Dohme.