Predictors of lowering SBP to assigned targets at 12 months in the Secondary Prevention of Small Subcortical Strokes study

John W. Graves, Carole L. White, Jeff M. Szychowski, Pablo E. Pergola, Oscar R. Benavente, Christopher S. Coffey, Lindsey N. Hornung, Robert G. Hart

    Research output: Contribution to journalArticle

    6 Citations (Scopus)

    Abstract

    Objective: Lowering blood pressure for secondary stroke prevention remains a challenge. These analyses were conducted to identify factors predicting achievement of SBP targets in the Secondary Prevention of Small Subcortical Strokes (SPS3) study. Methods: SPS3 is a randomized trial assigning patients with lacunar stroke to two targets of SBP control (130-149 mmHg or <130 mmHg). Logistic regression models were used to identify patient and SPS3 site characteristics predictive of lowering SBP to target at the 12-month study visit. Results: Of those above target at baseline (n = 1041), 69% were within their assigned target at 12 months. In the model with baseline characteristics only, those receiving treatment for hypertension at baseline were 68% less likely to achieve target [odds ratio (OR) = 0.32; 95% confidence interval (CI) = 0.17-0.60], whereas those of Hispanic ethnicity were 1.49 times more likely (95% CI = 1.09-2.03) to achieve SBP target. When clinical site characteristics were added to the model, only treated hypertension at baseline remained significant. In addition, management at a larger site (OR = 1.51; 95% CI = 1.03-2.20), SBP in target at 6 months (OR = 2.39; 95% CI = 1.79-3.19), and medication adherence (OR = 2.73; 95% CI = 1.51-4.95) were positively associated with achieving target SBP. Missed appointments (OR = 0.55; 95% CI = 0.41-0.73) were negatively associated with lowering SBP to target at 12 months. Conclusion: These results demonstrate that it is feasible to achieve targets of SBP control in this multiethnic stroke cohort across multiple sites and countries. The results highlight the important variables reflecting clinical site management.

    Original languageEnglish (US)
    Pages (from-to)1233-1240
    Number of pages8
    JournalJournal of Hypertension
    Volume30
    Issue number6
    DOIs
    StatePublished - Jun 2012

    Fingerprint

    Secondary Prevention
    Stroke
    Confidence Intervals
    Odds Ratio
    Logistic Models
    Hypertension
    Lacunar Stroke
    Medication Adherence
    Hispanic Americans
    Appointments and Schedules
    Blood Pressure

    Keywords

    • blood pressure control
    • hypertension
    • lacunar stroke
    • predictors
    • Secondary Prevention of Small Subcortical Strokes Study
    • stroke

    ASJC Scopus subject areas

    • Internal Medicine
    • Physiology
    • Cardiology and Cardiovascular Medicine

    Cite this

    Graves, J. W., White, C. L., Szychowski, J. M., Pergola, P. E., Benavente, O. R., Coffey, C. S., ... Hart, R. G. (2012). Predictors of lowering SBP to assigned targets at 12 months in the Secondary Prevention of Small Subcortical Strokes study. Journal of Hypertension, 30(6), 1233-1240. https://doi.org/10.1097/HJH.0b013e328353968d

    Predictors of lowering SBP to assigned targets at 12 months in the Secondary Prevention of Small Subcortical Strokes study. / Graves, John W.; White, Carole L.; Szychowski, Jeff M.; Pergola, Pablo E.; Benavente, Oscar R.; Coffey, Christopher S.; Hornung, Lindsey N.; Hart, Robert G.

    In: Journal of Hypertension, Vol. 30, No. 6, 06.2012, p. 1233-1240.

    Research output: Contribution to journalArticle

    Graves, JW, White, CL, Szychowski, JM, Pergola, PE, Benavente, OR, Coffey, CS, Hornung, LN & Hart, RG 2012, 'Predictors of lowering SBP to assigned targets at 12 months in the Secondary Prevention of Small Subcortical Strokes study', Journal of Hypertension, vol. 30, no. 6, pp. 1233-1240. https://doi.org/10.1097/HJH.0b013e328353968d
    Graves, John W. ; White, Carole L. ; Szychowski, Jeff M. ; Pergola, Pablo E. ; Benavente, Oscar R. ; Coffey, Christopher S. ; Hornung, Lindsey N. ; Hart, Robert G. / Predictors of lowering SBP to assigned targets at 12 months in the Secondary Prevention of Small Subcortical Strokes study. In: Journal of Hypertension. 2012 ; Vol. 30, No. 6. pp. 1233-1240.
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    abstract = "Objective: Lowering blood pressure for secondary stroke prevention remains a challenge. These analyses were conducted to identify factors predicting achievement of SBP targets in the Secondary Prevention of Small Subcortical Strokes (SPS3) study. Methods: SPS3 is a randomized trial assigning patients with lacunar stroke to two targets of SBP control (130-149 mmHg or <130 mmHg). Logistic regression models were used to identify patient and SPS3 site characteristics predictive of lowering SBP to target at the 12-month study visit. Results: Of those above target at baseline (n = 1041), 69{\%} were within their assigned target at 12 months. In the model with baseline characteristics only, those receiving treatment for hypertension at baseline were 68{\%} less likely to achieve target [odds ratio (OR) = 0.32; 95{\%} confidence interval (CI) = 0.17-0.60], whereas those of Hispanic ethnicity were 1.49 times more likely (95{\%} CI = 1.09-2.03) to achieve SBP target. When clinical site characteristics were added to the model, only treated hypertension at baseline remained significant. In addition, management at a larger site (OR = 1.51; 95{\%} CI = 1.03-2.20), SBP in target at 6 months (OR = 2.39; 95{\%} CI = 1.79-3.19), and medication adherence (OR = 2.73; 95{\%} CI = 1.51-4.95) were positively associated with achieving target SBP. Missed appointments (OR = 0.55; 95{\%} CI = 0.41-0.73) were negatively associated with lowering SBP to target at 12 months. Conclusion: These results demonstrate that it is feasible to achieve targets of SBP control in this multiethnic stroke cohort across multiple sites and countries. The results highlight the important variables reflecting clinical site management.",
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    AU - Graves, John W.

    AU - White, Carole L.

    AU - Szychowski, Jeff M.

    AU - Pergola, Pablo E.

    AU - Benavente, Oscar R.

    AU - Coffey, Christopher S.

    AU - Hornung, Lindsey N.

    AU - Hart, Robert G.

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    N2 - Objective: Lowering blood pressure for secondary stroke prevention remains a challenge. These analyses were conducted to identify factors predicting achievement of SBP targets in the Secondary Prevention of Small Subcortical Strokes (SPS3) study. Methods: SPS3 is a randomized trial assigning patients with lacunar stroke to two targets of SBP control (130-149 mmHg or <130 mmHg). Logistic regression models were used to identify patient and SPS3 site characteristics predictive of lowering SBP to target at the 12-month study visit. Results: Of those above target at baseline (n = 1041), 69% were within their assigned target at 12 months. In the model with baseline characteristics only, those receiving treatment for hypertension at baseline were 68% less likely to achieve target [odds ratio (OR) = 0.32; 95% confidence interval (CI) = 0.17-0.60], whereas those of Hispanic ethnicity were 1.49 times more likely (95% CI = 1.09-2.03) to achieve SBP target. When clinical site characteristics were added to the model, only treated hypertension at baseline remained significant. In addition, management at a larger site (OR = 1.51; 95% CI = 1.03-2.20), SBP in target at 6 months (OR = 2.39; 95% CI = 1.79-3.19), and medication adherence (OR = 2.73; 95% CI = 1.51-4.95) were positively associated with achieving target SBP. Missed appointments (OR = 0.55; 95% CI = 0.41-0.73) were negatively associated with lowering SBP to target at 12 months. Conclusion: These results demonstrate that it is feasible to achieve targets of SBP control in this multiethnic stroke cohort across multiple sites and countries. The results highlight the important variables reflecting clinical site management.

    AB - Objective: Lowering blood pressure for secondary stroke prevention remains a challenge. These analyses were conducted to identify factors predicting achievement of SBP targets in the Secondary Prevention of Small Subcortical Strokes (SPS3) study. Methods: SPS3 is a randomized trial assigning patients with lacunar stroke to two targets of SBP control (130-149 mmHg or <130 mmHg). Logistic regression models were used to identify patient and SPS3 site characteristics predictive of lowering SBP to target at the 12-month study visit. Results: Of those above target at baseline (n = 1041), 69% were within their assigned target at 12 months. In the model with baseline characteristics only, those receiving treatment for hypertension at baseline were 68% less likely to achieve target [odds ratio (OR) = 0.32; 95% confidence interval (CI) = 0.17-0.60], whereas those of Hispanic ethnicity were 1.49 times more likely (95% CI = 1.09-2.03) to achieve SBP target. When clinical site characteristics were added to the model, only treated hypertension at baseline remained significant. In addition, management at a larger site (OR = 1.51; 95% CI = 1.03-2.20), SBP in target at 6 months (OR = 2.39; 95% CI = 1.79-3.19), and medication adherence (OR = 2.73; 95% CI = 1.51-4.95) were positively associated with achieving target SBP. Missed appointments (OR = 0.55; 95% CI = 0.41-0.73) were negatively associated with lowering SBP to target at 12 months. Conclusion: These results demonstrate that it is feasible to achieve targets of SBP control in this multiethnic stroke cohort across multiple sites and countries. The results highlight the important variables reflecting clinical site management.

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