Key result
Intensive SBP control yields an ~8% recurrent stroke rate, with recurrence predicted by large-vessel atherosclerosis.
Why the study?
Intensive SBP lowering to <130 mm Hg is recommended for secondary stroke prevention, yet it did not significantly reduce overall recurrent ischemic stroke in the SPS3 trial, prompting evaluation of baseline predictors of recurrence among patients assigned to the lower SBP target.
RCT
Randomized to lower SBP target (<130 mm Hg) in the parent SPS3 trial
Among patients with lacunar stroke receiving intensive blood pressure lowering (<130 mm Hg), baseline antiplatelet use and large-vessel atherosclerosis independently predict the residual 8.0% risk of recurrent ischemic stroke.
Answers are grounded in this paper and cite their sources.
Recurrent stroke risk persists under intensive SBP control; hypothesis-generating for targeted strategies in large-vessel atherosclerosis.
BACKGROUND: Intensive systolic blood pressure (SBP) lowering to <130 mm Hg is recommended in contemporary secondary stroke prevention guidelines; however, it did not significantly reduce overall recurrent ischemic stroke in the Secondary Prevention of Small Subcortical Strokes (SPS3) trial. In this post hoc secondary analysis of participant-level SPS3 trial data, we sought to identify baseline predictors of recurrent ischemic stroke among patients with lacunar stroke assigned to the lower SBP target in SPS3. METHODS: This post hoc secondary analysis included SPS3 participants randomized to the lower SBP target (<130 mm Hg). The primary outcome was centrally adjudicated recurrent ischemic or hemorrhagic stroke. Candidate predictors were evaluated with multivariable Cox proportional hazards regression and reported as hazard ratios (HRs) with 95% confidence intervals (CIs). CONCLUSIONS: In SPS3 participants assigned to intensive SBP control, 8.0% experienced recurrent ischemic stroke. Aspirin or clopidogrel use at the qualifying lacunar stroke and large-vessel atherosclerosis remained independent predictors of recurrence. These findings may help identify patients who require preventive strategies beyond intensive SBP lowering.
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Shakir et al. (2026) conducted an RCT in Lacunar stroke. Intensive systolic blood pressure lowering (<130 mm Hg) and baseline candidate predictors (aspirin/clopidogrel use, large-vessel atherosclerosis) was evaluated on Centrally adjudicated recurrent ischemic or hemorrhagic stroke. Intensive SBP control (<130 mm Hg) had an 8.0% recurrent ischemic stroke rate, with baseline aspirin/clopidogrel use and large-vessel atherosclerosis independently predicting recurrence.
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