Introduction:
The SPRINT trial demonstrated cardiovascular benefit for a target systolic blood pressure (SBP) <120 mm Hg, but the effect on primary stroke was neutral. The Secondary Prevention of Small Subcortical Strokes (SPS3) trial did not reduce secondary stroke with a target SBP <130 mm Hg. No trial has investigated the effect of the more intensive SPRINT target of <120 mm Hg on secondary stroke risk.
Methods:
We performed a secondary analysis of SPS3 and included patients with at least 10 SBP readings. The primary predictor is mean SBP from day 30 (to avoid confounding from the initial study intervention) to 2 years. The primary outcome is recurrent ischemic stroke from day 30 to 2 years. We fit Cox models to our outcomes to derive hazard ratios for recurrent stroke events.
Results:
We included 2,859 patients, of which 121 (4.2%) had ischemic stroke during follow-up. There were 321 patients with SBP <120 (mean=115.5 mm Hg) and 2,538 with SBP ≥120 (mean=134.6 mm Hg), with a respective recurrent stroke rate of 1.9% versus 4.5% (p=0.026). In the Cox model, the hazard ratio for stroke with mean SBP <120 mm Hg was 0.40 (95% CI, 0.18-0.92) (Figure 1) and after adjustment for potential confounders (age, sex, race, education, smoking, prior stroke, prior myocardial infarction) the hazard ratio was 0.39 (95% CI, 0.16-0.96).
Conclusion:
In patients with lacunar stroke, achieving the SPRINT intensive blood pressure goal of <120 mm Hg was associated with a lower risk of recurrent stroke. While the current study is underpowered and has bias, these preliminary results suggest that the SPRINT definition of intensive blood pressure reduction could be beneficial for secondary stroke prevention.
Randomized trial to assess safety and clinical efficacy of intensive blood pressure reduction in acute spontaneous intracerebral haemorrhage