Based on analysis of data from the Systolic Blood Pressure Intervention Trial (SPRINT) and Action to Control Cardiovascular Risk in Diabetes (ACCORD) BP trial, intensive lowering of systolic blood pressure (BP) does not increase the risk for stroke in patients with hypertension, despite extremely low mean arterial pressure and pulse pressure. This study was published in the journalAnnals of Clinical and Translational Neurology.
Researchers assessed data on baseline and follow-up BP measurements of 9361 participants from the SPRINT and 4731 participants from ACCORD BP trial to determine the minimal arterial pressure and average pulse pressure during the study period against risk of stroke, hypotension, and syncope, with death as a competing risk.
The pooled results from SPRINT trial showed no increased risk for incident stroke with a mean arterial pressure <60 mm Hg vs 80–89 mm Hg (HR, 0.44; P=.29). Risk for stroke was higher with minimal mean arterial pressure >90 mm Hg (HR, 3.47; P<.0001). Minimal mean arterial pressure <60 mm Hg (HR, 3.75; P<.001) and between 60- and 69-mm Hg (HR, 1.78; P=.028) was associated with higher risk for hypotension.
The pooled results from the ACCORD trial revealed no higher stroke risk with minimal mean arterial pressure <60 mm Hg (HR, 2.90; P=.09). No association was seen between low achieved pulse pressure and increased stroke risk in either the SPRINT or ACCORD participants. There was no association between mean arterial pressure and pulse pressure values and the risk of syncope.
Based on the finding of this study, authors said, “our finding may encourage clinicians in treating hypertensive patients to the lower BP levels that were targeted in ACCORD BP trial and SPRINT without concern for lowering mean arterial pressure or pulse pressure.”
