Key result
Among patients with recent ischemic stroke, very low to normal systolic blood pressure (<120mmHg) was associated with a higher rate of recurrent stroke at 6 months compared to high SBP (>140mmHg) (4.5% vs 3.4%).
Why the study?
Does tight systolic blood pressure control prevent recurrent stroke in patients with established cardiovascular disease or recent ischemic stroke?
Does tight systolic blood pressure control prevent recurrent stroke in patients with established cardiovascular disease or recent ischemic stroke?
Absolute Event Rate: 4.5% vs 3.4%
Tight blood pressure control (<120 mmHg) early after an ischemic stroke may paradoxically increase the risk of recurrent stroke, highlighting the importance of timing in secondary prevention.
We have read with interest the article by Lee et al1 recently published in your journal. In this meta-analysis of 11 randomized controlled trials, the authors concluded that achieving tight systolic blood pressure (SBP) control did not provide additional stroke protection among people with established cardiovascular disease. However, if we are talking specifically about stroke prevention, it is essential to clarify which population we are referring to, allow us to generalize conclusions. First, in this meta-analysis established cardiovascular disease does not include patients with previous stroke (Table 1 in Lee et al1), and this should be pointed out. Second, recently Dorresteijn et al,2 using the data of 5,788 patients with symptomatic vascular disease, including patients with cerebrovascular disease (n = 1,178), concluded that although SBP level was positively related to vascular events, including stroke, low SBP levels were not associated with increased occurrence of stroke. However, if we specifically refer to large-scale prospective trials published on the treatment of hypertension in the secondary prevention of stroke, the time between the ischemic event and the inclusion of the patient in the trial seems to be essential. Thus, although the PROGRESS3 trial enrolled patients within 5 years of their index event and did not find a J-shaped association between SBP and recurrent stroke, in a recent post hoc analysis of the PROFESS trial,4 with 20,330 patients who experienced an ischemic stroke within 120 days prior to randomization, researchers found that very low to normal SPB (<120mmHg) was associated with increased risk of recurrent stroke. Furthermore, in an analysis of a trial data set involving 3,680 patients with recent ischemic stroke,5 the rate of recurrent stroke among patients with very low to normal SPB (<120mmHg) was even higher than in those patients with high SBP (>140mmHg) within the first 6 months after stroke (4.5 vs 3.4%). Nothing to report.
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Castilla‐Guerra et al. (2012) conducted a letter in Cardiovascular disease and stroke. Very low to normal systolic blood pressure (<120mmHg) vs. High systolic blood pressure (>140mmHg) was evaluated on Recurrent stroke. Among patients with recent ischemic stroke, very low to normal systolic blood pressure (<120mmHg) was associated with a higher rate of recurrent stroke at 6 months compared to high SBP (>140mmHg) (4.5% vs 3.4%).
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