Achieved Blood Pressures in the Secondary Prevention of Small Subcortical Strokes (SPS3) Study: Challenges and Lessons Learned

作者：Pergola Pablo E; White Carole L^*; Szychowski Jeff M; Talbert Robert; del Brutto Oscar; Castellanos Mar; Graves John W; Matamala Gonzalo; Javier Pretell Edwin; Yee Jerry; Rebello Rosario; Zhang Yu; Benavente Oscar R

来源：American Journal of Hypertension, 2014, 27(8): 1052-1060.

DOI：10.1093/ajh/hpu027

• achieved blood pressures
• blood pressure
• blood pressure management
• hypertension
• ischemic stroke
• lacunar stroke
• stroke prevention

BACKGROUND %26lt;br%26gt;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. %26lt;br%26gt;METHODS %26lt;br%26gt;Patients with recent symptomatic lacunar stroke were randomized to 1 of 2 levels of systolic BP (SBP) targets: lower: %26lt; 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. %26lt;br%26gt;RESULTS %26lt;br%26gt;Mean SBP decreased for both groups from baseline to the last follow-up, 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 %26gt;= 150 mm Hg at both study entry (40%) and end-study visit (17%), as compared with whites (9%) and Hispanics (11%). %26lt;br%26gt;CONCLUSIONS %26lt;br%26gt;These results show that it is possible to safely lower BP even to a SBP goal %26lt; 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.

• 出版日期2014-8