Achieved blood pressures in the secondary prevention of small subcortical strokes (SPS3) study: Challenges and lessons learned

Pablo E. Pergola, Carole L. White, Jeff M. Szychowski, Robert Talbert, Oscar Del Brutto, Mar Castellanos, John W. Graves, Gonzalo Matamala, Edwin Javier Pretell, Jerry Yee, Rosario Rebello, Yu Zhang, Oscar R. Benavente

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15 Scopus citations

Abstract

Background Lowering blood pressure (BP) after stroke remains a challenge, even in the context of clinical trials. The Secondary Prevention of Small Subcortical Strokes (SPS3) BP protocol, BP management during the study, and achieved BPs are described here. methods Patients with recent symptomatic lacunar stroke were randomized to 1 of 2 levels of systolic BP (SBP) targets: lower: <130 mm Hg, or higher: 130-149 mm Hg. SBP management over the course of the trial was examined by race/ethnicity and other baseline conditions. results Mean SBP decreased for both groups from baseline to the last followup, from 142.4 to 126.7 mm Hg for the lower SBP target group and from 143.6 to 137.4 mm Hg for the higher SBP target group. At baseline, participants in both groups used an average of 1.7 ± 1.2 antihypertensive medications, which increased to a mean of 2.4 ± 1.4 (lower group) and 1.8 ± 1.4 (higher group) by the end-study visit. It took an average of 6 months for patients to reach their SBP target, sustained to the last follow- up. Black participants had the highest proportion of SBP =150 mm Hg at both study entry (40%) and end-study visit (17%), as compared with whites (9%) and Hispanics (11%). conclusions These results show that it is possible to safely lower BP even to a SBP goal <130 mm Hg in a variety of patients and settings, including private and academic centers in multiple countries. This provides further support for protocol-driven care in lowering BP and consequently reducing the burden of stroke.

Original languageEnglish (US)
Pages (from-to)1052-1060
Number of pages9
JournalAmerican Journal of Hypertension
Volume27
Issue number8
DOIs
Publication statusPublished - Aug 2014

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Keywords

  • Achieved blood pressures
  • Blood pressure
  • Blood pressure management
  • Hypertension
  • Ischemic stroke
  • Lacunar stroke
  • Stroke prevention

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Pergola, P. E., White, C. L., Szychowski, J. M., Talbert, R., Del Brutto, O., Castellanos, M., ... Benavente, O. R. (2014). Achieved blood pressures in the secondary prevention of small subcortical strokes (SPS3) study: Challenges and lessons learned. American Journal of Hypertension, 27(8), 1052-1060. https://doi.org/10.1093/ajh/hpu027