More intensive blood pressure-lowering therapy linked to reduced recurrent stroke risk

Key takeaways:

• Hypertension is a major risk factor for recurrent stroke in patients with stroke or TIA.
• More intensive BP-lowering therapy also was associated with reduced risk for other serious cardiovascular events.

More intensive blood pressure-lowering therapy was linked to reduced risk for recurrent stroke and major cardiovascular events in patients with stroke or transient ischemic attack, according to research in JAMA Neurology.

“Hypertension is a major risk factor for recurrent stroke in patients with ischemic and hemorrhagic stroke or transient ischemic attack,” Chia-Yu Hsu, MD, of the department of neurology at Chang Gung University College of Medicine in Taiwan, and colleagues wrote, “and blood pressure lowering is therefore a guideline-recommended strategy to prevent recurrent stroke.”

To evaluate the link between the extent of blood pressure reduction and recurrent stroke in patients with stroke or TIA, researchers searched PubMed, Embase, the Cochrane Central Register of Controlled Trials and ClinicalTrials.gov between January 1980 and June 2022 and identified 10 randomized clinical trials involving 40,710 patients (mean age, 65 years; 34% women).

The primary outcome of interest was recurrent stroke, while major cardiovascular events served as the main secondary outcome.

Of the 10 studies, which had a mean follow-up of 2.8 years, six compared antihypertensive drugs with placebo or no therapy, and four evaluated a lower blood pressure target vs. a higher blood pressure target. The mean baseline systolic and diastolic blood pressures were 146 mm Hg and 85 mm Hg in all trials.

Results of the meta-analysis and meta-regression showed that more intensive blood-pressure-lowering treatment was associated with a reduced risk for recurrent stroke in those diagnosed with stroke or TIA (absolute risk, 8.4% vs. 10.1%; RR = 0.83; 95% CI, 0.78-0.88) compared with less intensive treatment.

Researchers also reported that the magnitude of differential systolic and diastolic blood pressure reduction was associated with a lower risk for recurrent stroke in a log-linear fashion (systolic: regression slope = 0.06; 95% CI, 0.08 to 0.03; diastolic: regression slope = 0.17; 95% CI, 0.26 to 0.08).

More intensive therapy was similarly associated with a reduced risk for major cardiovascular events in these patients, according to analysis of nine trials (absolute risk, 12.0% vs. 13.7%; RR = 0.88; 95% CI, 0.83-0.92).

“These results might support the use of more intensive blood pressure reduction for secondary stroke prevention chronically,” Hsu and colleagues wrote.