Effect of Intensive Versus Standard Blood Pressure Control on Stroke Subtypes

• Type of Material: Article
• Authors: Clinton B Wright, National Institutes of Health, Bethesda; Alexander P Auchus, University of Mississippi; Alan Lerner, Case Western Reserve University; Walter T Ambrosius, Wake Forest School of Medicine; Hakan Ay, Harvard Medical School; Jeffrey T Bates, Michael E DeBakey VA Med Ctr; Jing Chen, Tulane School of Medicine; James F Meschia, Mayo Clinic; Suchita Pancholi, University of South Carolina; Vasilios Papademetriou, Georgetown University; Anjay Rastogi, University of California Los Angeles; Mary Sweeney, Emory University; James J Willard, Wake Forest School of Medicine; Jerry Yee, Henry Ford Hospital; Suzanne Oparil, University of Alabama Birmingham
• Language: English
• Date: 2021-04-01
• Publisher: LIPPINCOTT WILLIAMS & WILKINS
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2021, Wolters Kluwer Health
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1161/HYPERTENSIONAHA.120.16027
• Title of Journal or Parent Work: HYPERTENSION
• Volume: 77
• Issue: 4
• Start Page: 1391
• End Page: 1398
• Grant/Funding Information: Supported by contracts (HHSN268200900040C, HHSN268200900046C, HHSN268200900047C, HHSN268200900048C, and HHSN268200900049C) and an interagency agreement (A-HL-13-002-001) from the NIH, including the National Heart, Lung, and Blood Institute (NHLBI), the National Institute of Diabetes and Digestive and Kidney Diseases, the National Institute on Aging, and the National Institute of Neurological Disorders and Stroke. Several study sites were supported by Clinical and Translational Science Awards funded by the National Center for Advancing Translational Sciences of the NIH (Case Western Reserve University: UL1TR000439; Ohio State University: UL1RR025755; University of Pennsylvania: UL1RR024134 and UL1TR000003; Boston University: UL1RR025771; Stanford University: UL1TR000093; Tufts University: UL1RR025752, UL1TR000073, and UL1TR001064; University of Illinois: UL1TR000050; University of Pittsburgh: UL1TR000005; University of Texas Southwestern: 9U54TR000017-06; University of Utah: UL1TR000105-05; Vanderbilt University: UL1TR000445; George Washington University: UL1TR000075; University of California, Davis: UL1TR000002; University of Florida: UL1TR000064; University of Michigan: UL1TR000433; and Tulane University: P30GM103337 COBRE Award NIGMS). The trial was also supported in part with respect to resources and the use of facilities by the Department of Veterans Affairs.
• Keywords: RELIABILITY; UNITED-STATES; Cardiovascular System & Cardiology; CAUSATIVE CLASSIFICATION; ISCHEMIC-STROKE; SYSTEM; Peripheral Vascular Disease; blood pressure; Life Sciences & Biomedicine; hemorrhagic stroke; HEALTH; ASSOCIATION; ischemic stroke; Science & Technology; atherosclerosis; TRIAL; AGREEMENT; hypertension

Abstract

In the SPRINT (Systolic Blood Pressure Intervention Trial), the number of strokes did not differ significantly by treatment group. However, stroke subtypes have heterogeneous causes that could respond differently to intensive blood pressure control. SPRINT participants (N=9361) were randomized to target systolic blood pressures of <120 mm Hg (intensive treatment) compared with <140 mm Hg (standard treatment). We compared incident hemorrhage, cardiac embolism, large- and small-vessel infarctions across treatment arms. Participants randomized to the intensive arm had mean systolic blood pressures of 121.4 mm Hg in the intensive arm (N=4678) and 136.2 mm Hg in the standard arm (N=4683) at one year. Sixty-nine strokes occurred in the intensive arm and 78 in the standard arm when SPRINT was stopped. The breakdown of stroke subtypes across treatment arms included hemorrhagic (intensive treatment, n=6, standard treatment, n=7) and ischemic stroke subtypes (large artery atherosclerosis: intensive treatment n=11, standard treatment, n=13; cardiac embolism: intensive treatment n=11, standard treatment n=15; small artery occlusion: intensive treatment n=8, standard treatment n=8; other ischemic stroke: intensive treatment n=3, standard treatment n=1). Fewer strokes occurred among participants without prior cardiovascular disease in the intensive (n=43) than the standard arm (n=61), but the difference did not reach predefined statistical significance level of 0.05 (P=0.09). The interaction between baseline cardiovascular risk factor status and treatment arm on stroke risk did not reach significance (P=0.05). Similar numbers of stroke subtypes occurred in the intensive BP control and standard control arms of SPRINT.