June 3, 2011Annals of Neurology
Does achieving an intensive versus usual blood pressure level prevent stroke?
Why the study?
Does achieving an intensive systolic blood pressure level (<130 mmHg) prevent stroke compared to usual control (130-139 mmHg) in patients with or without established cardiovascular disease?
Population
11 randomized controlled trials pooling 42,572 participants, including subjects with risk factors but no…
Comparison
Active treatment group with achieved systolic… vs Comparator group with achieved SBP 130 to 139…
Design
Meta-analysis
Authors
Discussion
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Implication
Supports intensive SBP control (<130 mmHg) for stroke prevention; confirms benefit mainly in primary prevention.
Key Points
- To evaluate the efficacy of achieving tight versus conventional systolic blood pressure control for the prevention of stroke and major vascular events.
- Conducted a systematic review and meta-analysis of 11 randomized controlled trials comprising 42,572 participants identified through PubMed and reference lists.
- Compared active treatment groups achieving systolic blood pressure <130 mmHg against comparator groups achieving 130 to 139 mmHg.
- Achieving tight systolic blood pressure (mean 126.5 vs. 132.6 mmHg) lowered overall stroke risk (RR 0.80; 95% CI, 0.70-0.92; p < 0.01; 794 total events) and major vascular events (RR 0.91; 95% CI, 0.86-0.96; p < 0.001).
- Stroke risk decreased substantially in individuals with risk factors but without established cardiovascular disease (RR 0.49; 95% CI, 0.34-0.69), whereas those with established cardiovascular disease showed no significant reduction (RR 0.92; 95% CI, 0.83-1.03).
Structured PICO
Does achieving an intensive systolic blood pressure level (<130 mmHg) prevent stroke compared to usual control (130-139 mmHg) in patients with or without established cardiovascular disease?
P
Population
11 randomized controlled trials pooling 42,572 participants, including subjects with risk factors but no established cardiovascular disease and those with established cardiovascular disease.
I
Intervention
Active treatment group with achieved systolic blood pressure (SBP) <130 mmHg (mean achieved SBP 126.5 mmHg).
C
Comparator
Comparator group with achieved SBP 130 to 139 mmHg (mean achieved SBP 132.6 mmHg).
O
Outcome
Risk of strokehard clinical
Intensive blood pressure control (SBP <130 mmHg) reduces stroke risk compared to usual control (130-139 mmHg), but this benefit appears limited to patients with risk factors who do not yet have established cardiovascular disease.
Cite This Study
Lee et al. (2011) studied this question.