Document Detail


Blood-pressure targets in patients with recent lacunar stroke: the SPS3 randomised trial.
MedLine Citation:
PMID:  23726159     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Lowering of blood pressure prevents stroke but optimum target levels to prevent recurrent stroke are unknown. We investigated the effects of different blood-pressure targets on the rate of recurrent stroke in patients with recent lacunar stroke.
METHODS: In this randomised open-label trial, eligible patients lived in North America, Latin America, and Spain and had recent, MRI-defined symptomatic lacunar infarctions. Patients were recruited between March, 2003, and April, 2011, and randomly assigned, according to a two-by-two multifactorial design, to a systolic-blood-pressure target of 130-149 mm Hg or less than 130 mm Hg. The primary endpoint was reduction in all stroke (including ischaemic strokes and intracranial haemorrhages). Analysis was done by intention to treat. This study is registered with ClinicalTrials.gov, number NCT 00059306.
FINDINGS: 3020 enrolled patients, 1519 in the higher-target group and 1501 in the lower-target group, were followed up for a mean of 3·7 (SD 2·0) years. Mean age was 63 (SD 11) years. After 1 year, mean systolic blood pressure was 138 mm Hg (95% CI 137-139) in the higher-target group and 127 mm Hg (95% CI 126-128) in the lower-target group. Non-significant rate reductions were seen for all stroke (hazard ratio 0·81, 95% CI 0·64-1·03, p=0·08), disabling or fatal stroke (0·81, 0·53-1·23, p=0·32), and the composite outcome of myocardial infarction or vascular death (0·84, 0·68-1·04, p=0·32) with the lower target. The rate of intracerebral haemorrhage was reduced significantly (0·37, 0·15-0·95, p=0·03). Treatment-related serious adverse events were infrequent.
INTERPRETATION: Although the reduction in stroke was not significant, our results support that in patients with recent lacunar stroke, the use of a systolic-blood-pressure target of less than 130 mm Hg is likely to be beneficial.
FUNDING: National Institutes of Health-National Institute of Neurological Disorders and Stroke (NIH-NINDS).
Authors:
; O R Benavente; C S Coffey; R Conwit; R G Hart; L A McClure; L A Pearce; P E Pergola; J M Szychowski
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural     Date:  2013-05-29
Journal Detail:
Title:  Lancet     Volume:  382     ISSN:  1474-547X     ISO Abbreviation:  Lancet     Publication Date:  2013 Aug 
Date Detail:
Created Date:  2013-08-12     Completed Date:  2013-08-21     Revised Date:  2014-08-12    
Medline Journal Info:
Nlm Unique ID:  2985213R     Medline TA:  Lancet     Country:  England    
Other Details:
Languages:  eng     Pagination:  507-15     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 Elsevier Ltd. All rights reserved.
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00059306
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MeSH Terms
Descriptor/Qualifier:
Antihypertensive Agents / therapeutic use*
Blood Pressure / drug effects
Cerebral Hemorrhage / prevention & control
Female
Humans
Hypertension / physiopathology,  prevention & control*
Male
Middle Aged
Recurrence / prevention & control
Stroke, Lacunar / physiopathology,  prevention & control*
Systole
Time-to-Treatment
Treatment Outcome
Grant Support
ID/Acronym/Agency:
U01 NS038529/NS/NINDS NIH HHS; U01NS038529/NS/NINDS NIH HHS; UL1 TR000439/TR/NCATS NIH HHS
Chemical
Reg. No./Substance:
0/Antihypertensive Agents
Investigator
Investigator/Affiliation:
O R Benavente / ; R G Hart / ; P E Pergola / ; S Palacio / ; I Castro / ; A Farias / ; A Roldan / ; C Kase / ; I Gavras / ; H Lau / ; M Ogrodnik / ; N Allen / ; I Meissner / ; J Graves / ; D Herzig / ; J Covalt / ; B Meyer / ; C Jackson / ; P Gamble / ; N Kelly / ; J Warner / ; J Bell / ; B Demaerschalk / ; M Hogan / ; D Wochos / ; J Wieser / ; B Cleary / ; L Wood / ; J Hanna / ; T Zipp / ; S Bailey / ; D Cook / ; A Liskay / ; D Simcox / ; J Kappler / ; D Anderson / ; R Grimm / ; D Brauer / ; C Pettigrew / ; A Vaishnov / ; P Sawaya / ; A Fowler / ; N Hughes / ; J Rice / ; K Vanderpool / ; S Cruz-Flores / ; H D Walden / ; E Holzemer / ; S Santhakumar / ; R Van Stavern / ; S Chatuverdi / ; J Flack / ; F Mada / ; D Wiseman / ; E Berlow / ; J Klinker / ; D Chiu / ; A Taylor / ; L Katz / ; B Coull / ; L Howard / ; M Malekniazi / ; M VanSkiver / ; D Bruck / ; S Redman / ; W Logan / ; D Carpenter / ; S Schroer / ; A Katramados / ; B Silver / ; J Yee / ; K Aiello / ; K Wilson / ; S McCarthy / ; B Dandapani / ; C P Spies / ; C Vasile / ; B Anthony / ; J Ferguson / ; S Krubel / ; A Synman / ; N Andrews / ; H Kirshner / ; C Sussman / ; D Brown / ; M Elkind / ; R J Crew / ; J Radhakrishan / ; T E Corporan / ; J Diaz / ; R Aragon / ; A Slivka / ; Dan Spetie / ; J Agriesti / ; P Notstein / ; D Naritoku / ; R Zweifler / ; M Culpepper / ; M Parnell / ; R Yunker / ; K Boots / ; R Drinkard / ; R Backlin / ; C Benesch / ; J Bisognano / ; A Leonhardt / ; J Zentner / ; M Hildreth / ; M Johnson / ; Y Liu / ; R Goldsteen / ; A Blair / ; G Wright / ; N Gathua / ; D Book / ; S Eapen / ; C Grimm / ; B Blaney / ; S Rozman / ; L Gaertner / ; E Bradenburg / ; L Loomis / ; J Monarch-Cotton / ; J Ravavelli-Meyer / ; A Golembieski / ; S W Burgin / ; J Hollander / ; W Polashenski / ; P Wallace / ; C Weber / ; H Lutsep / ; D Girard / ; K Seisler / ; M Cingel / ; M Ross / ; R Stone / ; D Larsen / ; A Doherty / ; L David / ; P Levy / ; N Buchheimer / ; S Vaughn / ; E Smith / ; J Satterfield / ; D Tirschwell / ; C Logar / ; M Ryan / ; G Schubert / ; P Tanzai / ; T Mirsen / ; S McAllister / ; A Bastien / ; P Niblack / ; J Frey / ; C Darbonne / ; P Karanjia / ; N Murali / ; R Dart / ; K Mancl / ; R Atkinson / ; R Lieberman / ; T Carter / ; P Zrelak / ; N Kenney / ; M Jacoby / ; D Jones / ; J DeFrancisco / ; T Hamm / ; J Romano / ; G Ortiz / ; M del Carmen Lichtenberger / ; R Linas / ; S Kravet / ; J Alt / ; S Sundararajan / ; M Rahman / ; T Horvath / ; D Korosec / ; C Murphy / ; J Greenberg / ; L Lennihan / ; M King / ; L Tenteromano / ; M Frankel / ; J Doyle / ; J Braimah / ; L Pereira / ; M Ching / ; R Sawyer / ; K Parkes / ; C Conover / ; E Albakri / ; G Ramirez / ; S Segal / ; K Taylor / ; J Jackson / ; K Helgason / ; M Hillmann / ; R Ringel / ; N Fleming / ; B Mckown / ; S Cohen / ; R Jenders / ; R Singh / ; M-T La / ; K Trinh / ; J Weinberger / ; L Wright / ; D Burch / ; R Horowitz / ; S Atlas / ; S Augustine / ; R Van Stavern / ; A Brown / ; J Serna / ; J Newgent / ; J Naylor / ; L Carpenter / ; T Warwick / ; S Stoltz / ; R Garcia / ; M Scheck / ; L Chadwick / ; J Fleck / ; M Weinberger / ; A Sears / ; C Fanale / ; L Neeper / ; P Fisk / ; S Cohen / ; D Sabry / ; R Phoenix / ; D Tong / ; M Garcia / ; A Mackey / ; J Morin / ; A Haché / ; C Lessard / ; R Côté / ; L Green / ; L Wadup / ; A-M Fontaine / ; G Gubitz / ; R Rebello / ; T Dean / ; Y Reidy / ; M Sharma / ; G Stotts / ; H Clark / ; M Mortensen / ; J Sauve / ; D Sharma / ; M Savage / ; J Minuk / ; L Trudeau / ; C Schanz / ; L Berger / ; S Brunet / ; J Pontbriand / ; M Mainville / ; D Racicot / ; M Hill / ; K Fischer / ; A Cole-Kaskayne / ; C Keeney / ; A Shuab / ; K Khan / ; N Dean / ; F Herbert / ; K Kastelic / ; E J Pretell / ; J Valdivia / ; M Pretell / ; O del Brutto / ; R Santibáñez / ; J Lara / ; M Zambrano / ; A Arauz / ; G A Cervantes / ; A Leyva / ; I Camacho / ; J L Ruiz Sandoval / ; E Salcido Vásquez / ; C Ruiz / ; C Cantú Brito / ; M Fernández / ; J F Góngora-Rivera / ; J M Escamilla / ; J Moxica / ; G Arciniega / ; W J Gonzalez / ; G Matamala / ; H Goecke / ; M Parra / ; J Pozo / ; J Tapia / ; I E Godoy / ; M Valdes / ; C Estol / ; C Peralta / ; A Ellenberg / ; D Chezzio / ; M M Fernández Pardal / ; H Trimachi / ; P Bonardo / ; J Mazziotti / ; R C Rey / ; G Caruso / ; L Melamud / ; S Lepera / ; A P Stilman / ; S Ameriso / ; R Sánchez / ; G Bruera / ; J Moschini / ; M J Ramírez / ; J A Bueri / ; S Sevilla / ; B de Ambrosi / ; G Marinsalta / ; F Rubio / ; Y Krupinski / ; A Carvajal / ; J Roquer / ; A Oliveras Serrano / ; J Jiménez Conde / ; A Rodríguez / ; G Romeral / ; A Arboix / ; A Pelegrí / ; L Blanco / ; D Cánovas Vergé / ; J Estela Herrero / ; A Gómez / ; L Blanco / ; J S Leal / ; M Castellanos / ; V Cruz / ; M Cepeda / ; M Gomis / ; J Arenillas / ; A Dávalos / ; A Suñol / ; S Reverté / ; J Lluis / ; M-V Sergio / ; R Marín / ; J Castillo Sánchez / ; M Blanco / ; Manuel Rodríguez / ; I Jiménez / ; J Rodríguez / ; E Díez Tejedor / ; P Martínez / ; B Fuentes / ; L Soler Singla / ; E Balaguer / ; J Izquierdo / ; C Soler / ; M Armenteros / ; O R Benavente / ; R G Hart / ; P E Pergola / ; A Shepherd / ; A Roldan / ; M-F Benavente / ; C White / ; C Robu / ; C Kelly / ; R Talbert / ; E Martinez / ; C Bazan / ; G Pergola / ; L A Pearce / ; R Costello / ; C Jacova / ; L Camelia / ; C Mendoza / ; B Pratt / ; B Kin / ; S Holliday / ; L A McClure / ; C Coffey / ; J M Szychowski / ; G Howard / ; C Katholi / ; Yu Zhang / ; K Peri / ; C Allcorn / ; R Mailhot / ; L Irby / ; F Guyton / ; M J Sewell / ; R Ringer / ; D Raisch / ; D Hunt / ; F Rubio / ; C M Rosso / ; A Martin / ; M Sanllorente / ; C Arabetti / ; J Luis Fernández / ; M J Cremona / ; A Capece / ; O R Benavente / ; R G Hart / ; M-F Benavente / ; C Coffey / ; R Conwit / ; L A McClure / ; P E Pergola / ; A Roldan / ; J M Szychowski / ; R Talbert / ; O R Benavente / ; D Anderson / ; A Arauz / ; M-F Benavente / ; C Coffey / ; R Conwit / ; R Côté / ; B Demaerschalk / ; O del Brutto / ; M Elkind / ; R G Hart / ; C Kase / ; L A McClure / ; C Moy / ; P E Pergola / ; A Roldan / ; M Sharma / ; J M Szychowski / ; R Talbert / ; C White / ; C White / ; O R Benavente / ; C Benesch / ; C Coffey / ; R Conwit / ; J Graves / ; R Grimm / ; G Gubitz / ; S Holliday / ; H Lau / ; C Moy / ; L A Pearce / ; J M Szychowski / ; M Aguilar / ; D Sherman / ; E Nasco / ; J Blackshear / ; M Chung / ; P Fayad / ; B Gage / ; C Johnston / ; W Kernan / ; E Leira / ; J Merino / ; G Roman / ; C Sila / ; G Sung / ; C van Walraven / ; R Zweifler / ; B Stern / ; R Conwit / ; C Moy / ; K M Welch / ; W Clarke / ; J Cutler / ; K Furie / ; K Johnston / ; M Mayo / ; C S Coffey /
Comments/Corrections
Comment In:
Lancet. 2014 Feb 8;383(9916):512-3   [PMID:  24506903 ]
Lancet. 2014 Feb 8;383(9916):512   [PMID:  24506904 ]
Lancet. 2013 Aug 10;382(9891):482-4   [PMID:  23726160 ]
Erratum In:
Lancet. 2013 Aug 10;382(9891):506
Note: Coffey, C S [aded]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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