Maintaining blood pressure, BP at 130/80 mm Hg is the best way to reduce stroke recurrence. A new Japan-based randomized controlled trial and meta-analysis has revealed that if the blood pressure of our body is maintained under 130/80 mm Hg it can eventually reduce the risk of having a repeat stroke. The study was presented by Kazuo Kitagawa, of Tokyo Women’s Medical University, Japan, at the International Stroke Conference 2019.
Intensive BP lowering did not significantly reduce stroke recurrence, according to data from the RESPECT study
Hypertension and stroke are dynamically correlated to each other. It is well established that Intensive blood pressure control particularly important for the prevention of hemorrhagic stroke.Be it in the context of managing ischemic or hemorrhagic stroke, selecting an appropriate blood pressure (BP). The management of hypertension in stroke is determined by timing, the type of stroke, use of thrombolysis, concurrent medical conditions, and pharmacologic variables.
Prior studies have that revealed that 51 % of stroke deaths are attributable to high systolic BP and local rates of incidence of stroke are correlated with the prevalence of hypertension. Blood pressure is a major determinant of both ischemic and hemorrhagic stroke and correlates with the risk of the first as well as recurrent episodes of cerebrovascular incidents. Therefore, the optimum range of BP must be recognized in order to formulate an effective strategy for BP control.
To conduct the RESPECT study, patients in Japan who had a recent, CT- or MRI-defined symptomatic ischemic or hemorrhagic stroke were randomized in an open-label design to intensive blood pressure control of less than 140/90 mm Hg or intensive blood pressure control of less than 120/80 mm Hg. The primary endpoint was the time to the first recurrent stroke, including ischemic stroke and intracerebral haemorrhage.
Patients were recruited between October 2010 and December 2015 in a 1:1 design, with the intention of recruiting 2000 patients. For the open-label trial, between October 2010 and December 2015, patients were randomly assigned to standard treatment (BP control to < 140/90 mm Hg) or to intensive treatment (BP control to < 120/80 mm Hg). The trial was stopped, however, on December 31, 2016, after enrollment of 1263 patients, due to the cessation of funding. Of these patients, 630 in the standard-treatment group and 633 in the intensive-treatment group were followed up for a mean of 3.9 years.
In all, 91 first recurrent strokes occurred. The hazard ratio for cumulative incidence of recurrent stroke with intensive versus standard blood pressure treatment was 0.73. While the hazard ratio in the standard versus intensive blood pressure groups was not significant, at 0.91 for ischemic stroke, it was significant, at 0.09, for intracerebral haemorrhage.
In an updated meta-analysis of randomized trials presented by the study authors that comprised 2454 patients, including the patients from RESPECT,he hazard ratio for the cumulative incidence of recurrent stroke with intensive versus standard blood pressure treatment was 0.78.
The researchers concluded that “The nonsignificant findings might be attributable to insufficient statistical power due to early termination of the trial or the modest difference in blood pressure level between groups”. “Nevertheless, the updated meta-analysis including this trial supports the target blood pressure of less than 130/80 mm Hg in the secondary prevention of stroke, ”Kitagawa and colleagues wrote.
For further reference log on to :
Kitagawa K, et al. LB10. Presented at: International Stroke Conference; Feb. 6-8, 2019; Honolulu.