Journal article
Achieved Blood Pressure and Outcomes in the Secondary Prevention of Small Subcortical Strokes Trial
Hypertension (Dallas, Tex. 1979), v 67(1), pp 63-69
01 Jan 2016
PMID: 26553236
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Studies suggest a J-shaped association between blood pressure and cardiovascular events in the setting of intensive systolic blood pressure control; whether there is a similar association with stroke remains less well established. The Secondary Prevention of Small Subcortical Strokes was a randomized trial to evaluate higher (130-149 mm Hg) versus lower (<130 mm Hg) systolic blood pressure targets in participants with recent lacunar infarcts. We evaluated the association of mean achieved blood pressure, 6 months after randomization, and recurrent stroke, major vascular events, and all-cause mortality. After a mean follow up of 3.7 years, there was a J-shaped association between achieved blood pressure and outcomes; the lowest risk was at approximate to 124 and 67 mm Hg systolic and diastolic blood pressure, respectively. For example, above a systolic blood pressure of 124 mm Hg, 1 standard deviation higher (11.1 mm Hg) was associated with increased mortality (adjusted hazard ratio: 1.9; 95% confidence interval: 1.4, 2.7), whereas below this level, this relationship was inverted (0.29; 0.10, 0.79), P<0.001 for interaction. Above a diastolic blood pressure of 67 mm Hg, a 1 standard deviation higher (8.2 mm Hg) was associated with an increased risk of stroke (2.2; 1.4, 3.6), whereas below this level, the association was in the opposite direction (0.34; 0.13, 0.89), P=0.02 for interaction. The lowest risk of all events occurred at a nadir of approximate to 120 to 128 mm Hg systolic blood pressure and 65 to 70 mm Hg diastolic blood pressure. Future studies should evaluate the impact of excessive blood pressure reduction, especially in older populations with preexisting vascular disease.
Metrics
Details
- Title
- Achieved Blood Pressure and Outcomes in the Secondary Prevention of Small Subcortical Strokes Trial
- Creators
- Michelle C. Odden - Oregon State UniversityLeslie A. McClure - Drexel UniversityB. Peter Sawaya - University of KentuckyCarole L. White - Health Restoration & Care System ManagementCarmen A. Peralta - University of California, San FranciscoThalia S. Field - University of British ColumbiaRobert G. Hart - Population Health Research InstituteOscar R. Benavente - University of British ColumbiaPablo E. Pergola - Renal Associates P. A.
- Publication Details
- Hypertension (Dallas, Tex. 1979), v 67(1), pp 63-69
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 7
- Grant note
- R01AG046206 / NATIONAL INSTITUTE ON AGING; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute on Aging (NIA) U01NS038529 / National Institute of Neurological Disorders and Stroke; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Neurological Disorders & Stroke (NINDS) K01AG039387; R01AG46206 / National Institute on Aging; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute on Aging (NIA)
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Epidemiology and Biostatistics
- Web of Science ID
- WOS:000366254800013
- Scopus ID
- 2-s2.0-84951566739
- Other Identifier
- 991019174791304721
UN Sustainable Development Goals (SDGs)
This publication has contributed to the advancement of the following goals:
InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Peripheral Vascular Disease