Takeaway
- Among patients who have experienced stroke, a target BP of <130/80 mmHg is superior to one of <140/90 mmHg for reducing recurrence risk.
Why this matters
- Optimal target for secondary stroke prevention is unclear.
Key results
- Trial stopped early for slow recruitment, funding cessation.
- During mean 3.9-year follow-up, mean BP:
- 133.2/77.7 mmHg in standard control group.
- 126.7/74.4 mmHg in intensive control group.
- Vs standard control, intensive control yielded nonsignificant reduction in recurrent stroke risk (HR, 0.73; P=.15).
- Pooled meta-analysis of this trial with 3 previous trials (SPS3, PAST-BP, PODCAST) favored intensive control:
- Relative risk, 0.78 (P=.02).
- Absolute risk difference, −1.5% (95% CI, −2.6% to −0.4%).
- Number needed to treat, 67 (95% CI, 39-250).
Expert comment
- In an editorial, Craig S. Anderson, MD, PhD, writes, “Globally, just under half of the total BP-attributable disease burden occurs in people with systolic BP less than 140 mmHg, and most CV events occur in individuals who have had a previous event….Therefore, any recommendations for the initiation, intensification, and control of BP-lowering treatment for high-risk patients has substantial clinical and public health importance.”
Study design
- Japanese randomized controlled trial (RESPECT trial; 1514 patients) and updated meta-analysis (4 randomized controlled trials, 4895 patients) comparing intensive vs standardized BP control among patients with previous stroke.
- Main outcome: recurrent stroke.
- Funding: Merck & Co., Inc., Kenilworth, NJ, USA; Bristol-Myers Squibb; Towa Pharmaceutical Co, Ltd; Omron Corporation.
Limitations
- Trial lacked power for primary endpoint.
- Treatment assignment not masked.
- None of the trials individually showed significant difference.
References
References